Pectus excavatum

Background:

• Sternum depressed towards vertebral column, greatest depression at level of xiphoid process
• Believed to result from abnormal development of costal cartilages
• Associated with connective tissue disorders such as Marfan's
• Can be identified at birth, or as late as adolescent years

Implications

• Cosmetic deformity
• Significant cardiopulmonary impairment is possible

Evaluation

• Symptoms at rest are rare, but may have impaired exercise tolerance
• Check for asymmetry (present in many)
• Check deepest point of pectus compared to maximal diameter at lateral chest wall - a ratio of >2.5x is significant deformity
• Check for Marfan's clinically
• CT - can be used to calculate Haller index (>3.5 should have repair)
• TTE
• RFTs

Treatment

• Delay surgery until puberty to avoid Jeune syndrome
• Open repair (Ravitch operation)
• Minimally invasive (Nuss repair)

Complications of Nuss repair

• Pneumothorax
• Urinary retention is common (unclear why)
• Intra-operative cardiac perforation - rare but lethal
• Displacement of bar - requires re-operation
• Allergy to bar metal