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About Pectus Excavatum

The Pectus Excavatum is the most common congenital chest cavity deformity and is characterised by a concave depression of the sternum, better known as sunken chest or funnel chest. Undoubtedly, the defining feature of Pectus Excavatum is the sunken appearance of the sternum.

It is a progressive condition which can be visible from birth, but typically becomes more obvious over the years. It occurs in 1 in every 1,000 births, predominantly in males (by a ratio of 3:1). It has been noted that this deformity is hereditary in 35% to 45% of cases.

Pectus Excavatum may present in varying degrees. There are patients with a mild deformity, almost asymptomatic though with aesthetic implications, and others who present with a moderate or severe deformity who develop serious physical problems and socio-psychological disorders.

Pectus Excavatum may also be linked to Marfan*or Poland** syndromes.

Paediatricians or GPs are usually the first professionals consulted by patients looking to request information about Pectus Excavatum. If the patient is under the age of six and asymptomatic, there is no need for either additional tests or surgery. If older, then an annual check-up is important to monitor whether or not the defect is progressive. If the defect worsens or symptoms related to Pectus Excavatum occur, the patients need to be assessed by a paediatric or thoracic surgeon to get the best treatment for their specific Pectus Excavatum.

What is the diagnosis of the Pectus Excavatum?

Patients affected by this chest deformation should make an appointment for a clinical evaluation. Diagnostic tests for the Pectus Excavatum typically include computed tomography (CT), pulmonary function tests (spirometry), and cardiac tests (electrocardiogram and
 echocardiogram).sintomatologia-1

Through CT, the Haller Index is measured, that is, the ratio of transverse diameter (the horizontal distance inside the rib cage) and the anteroposterior diameter (the shortest distance between the vertebrae and the sternum) in the cut of maximum sinking of the thorax. A Haller’s index equal to or greater than 3.25 is defined as severe and may be an indication for the surgical treatment of Pectus Excavatum.

What are the symptoms of Pectus Excavatum?

Pectus Excavatum symptoms can lead to lung problems, making it difficult to breathe and other respiratory symptoms. They can also appear in heart problems that lead to a lack of adaptation to physical activity. Another frequent affectation is a bad position of the vertebral column that, in some cases, appears as a true deviation or scoliosis 

Furthermore, the patient with Pectus Excavatum may suffer psychological disorders that may lead to a tendency to isolation and loneliness, which can be very relevant.

Spontaneous regression or any partial improvement in symptoms of sunken chest are rare.

Poor posture, not exercising and do not have strong muscles (especially back) contribute the deformity worse.

 

Surgical treatment for Pectus Excavatum

Currently there are various techniques for the treatment for Pectus Excavatum, both surgical and non-surgical.

Pectus Excavatum surgical intervention is indicated in the following situations: Haller’s index equal to or greater than 3.25, progression of the deformity, existence of restrictive or obstructive lung disease, previous failure in the treatment of Pectus Excavatum, compression or cardiac displacement, or a prolapse of the mitral valve.

Currently there is a new treatment for sunken chest, the surgical method called Taulinoplastia, which gives the opportunity to fix the Pectus Excavatum in a minimally invasive way, by means an extrathoracic technique. Taulinolplastia uses a surgical kit called Pectus Up Surgery Kit. It consists of an implant, the Pectus Up, which is placed subcutaneously, and a set of surgical tools. Taulinoplastia is a minimally invasive, painless surgical procedure that involves a short  period of convalescence and is free of serious complications. The implant is removed after 3-4 years with a very simple and risk-free procedure, although it can remain for much longer in the patient.

Taulinoplastia opens up new prospects in the surgical treatment of the funnel chest both for patients, creating more cartaintly and increasing the age range to be treated, and for professionals, facilitating the surgical process thanks to its low complexity.


* Marfan Syndrome: This syndrome is characterised by a disorder of connective tissue affecting the skeletal and cardiovascular systems. In most cases, it is inherited and passed down from fathers to children; however, up to 30% of patients have no family history of the condition.
** Poland syndrome: it is a congenital disorder consisting of the total or partial absence of the pectoralis major muscle, the absence of rib cartilages or ribs. It can be associated with other pectoral, cervical, intrathoracic and even brachial deformities.