Congenital Chest Wall Deformities
There are two basic types of congenital chest wall deformities: Pectus Excavatum (sunken chest), and Pectus Carinatum (a protuberant or "pigeon chest").
Some patients are born with a combination of the two, which creates an asymmetric deformity. While both kinds of patients may have chest pain from the deformity, excavatum patients commonly complain of shortness of breath and early fatigue during aerobic exercise.
Pectus Excavatum (Sunken Chest)
Traditionally, large incisions have been made across the front of the chest to allow the resection of abnormally shaped rib cartilage and a surgical cut (osteotomy) across the sternum (breastbone). This procedure allowed the deformity to be corrected but resulted in scarring and long term rigidity of the chest wall. Surgeons in the Division of Pediatric Surgery are utilizing newer, minimally invasive approaches to correct congenital chest wall deformities.
Pectus Excavatum is now repaired utilizing the Nuss approach, which works like braces on misaligned teeth to lift the sternum and reshape the chest wall. The U-shaped bar is introduced from the side of the chest, using thoracoscopic visualization for optimal placement. The bar is left in place for two years and is then removed as an outpatient procedure.
In 1999, Dr. Nuss, who invented the technique, traveled from his hospital in Virginia to visit Children's Hospital Los Angeles. Our pediatric surgeons took advantage of this visit and, for the past 10 years, have been using this procedure to correct Pectus Excavatum. Since then, the technique has been used in nearly 100 patients.
Ideally, the Nuss procedure is performed until at least 14 years of age, before the chest wall becomes rigid. Postoperatively, the patient’s ability to breathe and exercise is often significantly improved within a few months.
In the future, it is possible that excavatum defects may be corrected utilizing an implantable magnet which will allow for the correction of excavatum defects at an even earlier age. This research is ongoing and initial results are encouraging.
Pectus Carinatum (Pigeon Chest)
Pectus Carinatum can now be corrected using an externally applied, custom made brace. Pediatric surgeons at our hospital have teamed with a local orthotics company to create a compression brace, which allows protuberant chest wall deformities to be reduced without surgery. The greatest success occurs in patients who are less than 15 years of age, ideally less than 12 years of age, when the chest walls are more flexible. Patients who wear their brace 23 hours per day typically see improvements in the first month. The brace is continually adjusted until the chest wall is flat, which typically occurs in three to six months.