Chest Wall Deformities

What is a chest wall deformity?

Chest wall deformities are abnormally shaped chest/thorax due to abnormal development of the ribs,cartilage or breast bone .Common types of chest wall deformities are pectus excavatum and pectus carinatum.

 

What is pectus excavatum and pectus carinatum?

Pectus excavatum or funnel chest is when the breastbone is depressed so chest appears sunken or hollow and pectus carinatum or pigeon chest wherein the breast bone is raised so the chest appears protruded.

 

How common?

The funnel chest defect is the more commoner type and it affects males more often than females occurring in about 1 in 500 births. In India such cases have been neglected as there are no referral centres and people had to go abroad to avail treatment.

 

What causes these chest wall deformities?

These are congenital defects where the exact cause is unknown, family history is present in 40 % of cases.

 

What kind of problems does pectus carinatum cause?

Patients get tired sooner than their peers as the defect prevents proper functioning of heart lungs. It also has psychosocial impact on patient’s self-image and confidence

 

What problems does pectus excavatum cause?

Depending on severity of deformity the heart and the lungs get compressed decreasing their functions.

  1. Exercise intolerance and shortness of breath: The parents notice their child cannot keep up with other children in physical activity.
  2. Chest pain which may be independent of exercise.
  3. Psychosocial effect: Poor body image, decreased self confidence and altered behavior: They avoid activities that involve removing their shirt, such as swimming.

 

What tests are required for a pectus excavatum evaluation?

Physical exam is required on every patient followed by chest x-ray and chest CT scan. They assess the severity of the deformity and degree of compression of the heart and lungs. An echocardiogram to evaluate heart function and pulmonary function tests to evaluate lung function is also done.

What is the age for treatment?

The younger the better, when the bones are soft and remodel easily with less pain. The ideal scene is a preschool child repaired at 3 years of age and bar removed at 5 years before starting school.

 

What are the treatment options for pectus excavatum?

For pectus excavatum, surgical repair can be accomplished in one of two ways.

 

Open technique:

The classic open Ravitch technique involves a big incision for repair of the deformity. It involves removal of the abnormal bones and cartilage and regrowth of the bones and cartilage. This causes a weak chest till the time of bone healing which can takes from months to years.

 

Minimally Invasive Repair:

The present day technique involves inserting a stainless steel bar through small incisions about 2 cm on either side of the chest under video guidance. This is referred to as the minimally invasive pectus repair. The bar is then secured after lifting the chest wall defects into normal position. The bone then remodels into normal shaped chest. As no bones are removed there is no chest wall weakness

 

How long will the bars be inside the chest?

The bars will be inside the chest for 2 years in children, 3 years in Teenager and adults. At the end 01 this period they are removed.

 

How long will my child be in the hospital?

The average stay for a person who undergoes the minimally invasive pectus repair is approximately five to seven days. By the time they are discharged from hospital they will he eating, walking, and comfortable. They may need to take some pills for the pain, these are stopped after a few days.

 

What to expect after surgical correction? Benefits are three folds;

  1. Physiology of heart and lung function improves.
  2. Psychosocial Improved self confidence.
  3. Cosmetic Normal lung shape and no big scar of incision.