| Signs and symptoms | | | | the chest and ribcage. One magnet is inserted 1 cm |
| The hallmark of the condition is a sunken appearance | | | | into the patients body on the lower end of the sternum, |
| of the sternum. The heart can be displaced and/or | | | | the other is placed externally onto a custom fitted |
| rotated. Mitral valve prolapse may also be present. | | | | brace. These two magnets generate around |
| Base lung capacity is decreased. | | | | 0.04 tesla (T) in order to slowly move the sternum |
| Causes | | | | outwards over a number of years. The maximum |
| Researchers are currently unsure as to the actual | | | | magnetic field that can be applied to the body safely is |
| cause of pectus excavatum but hypothesize genetic | | | | around 4 T, making this technique safe from a |
| defect. Approximately 37% of individuals with pectus | | | | magnetic viewpoint. The 3MP technique's main |
| excavatum have a first degree family member with | | | | advantages are that it is more cost-effective than |
| the condition. Physiologically, increased pressure in | | | | major surgical approaches such as the Nuss |
| utero, rickets and increased traction on the sternum | | | | procedure and it is considerably less painful |
| due to abnormalities of the diaphragm have been | | | | postoperatively. One potential adverse effect of 3MP |
| postulated as specific mechanisms. Pectus excavatum | | | | is inactivation of implanted devices such as an artificial |
| is also a relatively common symptom of Marfan | | | | pacemaker. Since the 3MP is still in a trial period it is |
| syndrome. Many children with Spinal Muscular Atrophy | | | | unknown whether long term wearing of the magnet |
| develop pectus excavatum due to the diaphragmatic | | | | will affect the skin or other vital organs. |
| breathing that is common with the disease. | | | | Epidemiology |
| Pathophysiology | | | | Pectus excavatum occurs in an estimated 1 in |
| Because the heart is located behind the sternum, and | | | | 150-1000 births, with male predominance |
| because individuals with pectus excavatum have been | | | | (male-to-female ratio of 3:1). Occurrences of the |
| shown to have visible deformities of the heart (seen | | | | condition in family members have been reported in |
| both on radiological imaging and after autopsies), it has | | | | 35% to 45% of cases. |
| been hypothesized that there is impairment of function | | | | In animals |
| of the cardiovascular system in individuals with pectus | | | | Pectus excavatum is also known to occur in animals, |
| excavatum. While some studies have demonstrated | | | | e.g. the Munchkin breed of cat. Some procedures used |
| decreased cardiovascular function in pectus | | | | to treat the condition in animals have not been used in |
| excavatum, there has been no consensus reached | | | | humans, such as the use of a cast with sutures |
| based on newer physiological tests (such as | | | | wrapped around the sternum and the use of internal |
| echocardiography) of the presence or degree of | | | | and external splints. These techniques are generally |
| impairment in cardiovascular function in people with | | | | used in immature animals with flexible cartilage. |
| pectus excavatum. Similarly, there is no consensus on | | | | See also |
| the degree of functional improvement after corrective | | | | Pectus carinatum |
| surgery. | | | | References |
| Diagnosis | | | | ^ chief lexicographer: Douglas M. Anderson (2003), |
| Cross sectional scan of a chest with pectus | | | | Pectus Excavatum (28 ed.), Dorland's Medicla |
| excavatum | | | | Dictionary: Saunders, ISBN 0721601464, |
| Pectus excavatum is initially suspected from visual | | | | ^ a b c d Shamberger RC (1996). "Congenital chest |
| examination of the anterior chest. Auscultation of the | | | | wall deformities". Curr Probl Surg 33 (6): 469542. |
| chest can reveal displaced heart beat and valve | | | | doi:10.1016/S0011-3840(96)80005-0. PMID 8641129. |
| prolapse. There can be a heart murmur occurring | | | | ^ a b c d Crump HW (1992). "Pectus excavatum". Am |
| during systole caused by proximity between the | | | | Fam Physician 46 (1): 1739. PMID 1621629. |
| sternum and the pulmonary artery. Lung sounds are | | | | ^ "Pectus excavatum". MedLine Plus Medical |
| usually clear yet diminished due to decreased base | | | | Encyclopedia. U.S. National Library of Medicine and the |
| lung capacity. | | | | National Institutes of Health. 2007-11-12. |
| Many scales have been developed to determine the | | | | ^ "Pectus Excavatum". |
| degree of deformity in the chest wall. Most of these | | | | ^ Spence, Roy A. J.; Patrick J. Morrison (2005). |
| are variants on the distance between the sternum and | | | | Genetics for Surgeons. Remedica Publishing. ISBN |
| the spine. One such index is the Backer ratio which | | | | 1-901346-69-2. excavatum&rid=gfs.section.344. |
| grades severity of deformity based on the ratio | | | | ^ a b c "eMedicine Pectus Excavatum". Andre |
| between the diameter of the vertebral body nearest | | | | Hebra. |
| to xiphosternal junction and the distance between the | | | | ^ "eMedicine Marfan Syndrome". Harold Chen. |
| xiphosternal junction and the nearest vertebral body. | | | | ^ Guller B, Hable K (1974). "Cardiac findings in pectus |
| More recently the Haller index has been used based | | | | excavatum in children: review and differential |
| on CT scan measurements. An index over 3.25 is | | | | diagnosis". Chest 66 (2): 16571. doi:10.1378/chest.66.2.165. |
| often defined as severe. The Haller index is the ratio | | | | PMID 4850886. |
| between the horizontal distance of the inside of the | | | | ^ BACKER OG, BRUNNER S, LARSEN V (1961). "The |
| ribcage and the shortest distance between the | | | | surgical treatment of funnel chest. Initial and follow-up |
| vertebrae and sternum. | | | | results". Acta Chir Scand 121: 25361. PMID 13685690. |
| Chest x-rays are also useful in the diagnosis. The | | | | ^ Jeannette Diana-Zerpa; Nancy Thacz Browne; Laura |
| chest x-ray in pectus excavatum can show an | | | | M. Flanigan; Carmel A. McComiskey; Pam Pieper |
| opacity in the right lung area that can be mistaken for | | | | (2006). Nursing Care of the Pediatric Surgical Patient |
| an infiltrate (such as that seen with pneumonia). Some | | | | (Browne, Nursing Care of the Pediatric Surgical |
| studies also suggest that the Haller index can be | | | | Patient). Sudbury, Mass: Jones & Bartlett |
| calculated based on chest x-ray as opposed to CT | | | | Publishers. p. 253. ISBN 0-7637-4052-7. |
| scanning in individuals who have no limitation in their | | | | ^ a b Haller JA, Kramer SS, Lietman SA (1987). "Use |
| function. | | | | of CT scans in selection of patients for pectus |
| Pectus excavatum is differentiated from other | | | | excavatum surgery: a preliminary report". J. Pediatr. |
| disorders by a series of elimination of signs and | | | | Surg. 22 (10): 9046. doi:10.1016/S0022-3468(87)80585-7. |
| symptoms. Pectus carinatum is excluded by the simple | | | | PMID 3681619. |
| observation of a collapsing of the sternum rather than | | | | ^ Hoeffel JC, Winants D, Marcon F, Worms AM (1990). |
| a protrusion. Kyphoscoliosis is excluded by diagnostic | | | | "Radioopacity of the right paracardiac lung field due to |
| imaging of the spine, where in pectus excavatum the | | | | pectus excavatum (funnel chest)". Rontgenblatter 43 |
| spine usually appears normal in structure. | | | | (7): 298300. PMID 2392647. |
| Treatment | | | | ^ Mueller C, Saint-Vil D, Bouchard S (2008). "Chest |
| Treatment for pectus excavatum can involve either | | | | x-ray as a primary modality for preoperative imaging |
| invasive or non-invasive techniques or a combination of | | | | of pectus excavatum". J. Pediatr. Surg. 43 (1): 713. |
| both. Before an operation proceeds several tests are | | | | doi:10.1016/j.jpedsurg.2007.09.023. PMID 18206458. |
| usually to be performed. These include, but are not | | | | ^ "How the Haller is measured. Departament of |
| limited to, a CT scan, pulmonary function tests, and | | | | Cardiology and Pulmonology of the Hospital das |
| cardiology exams (such as auscultation and ECGs). | | | | Clnicas da Faculdade de Medicina da Universidade de |
| After a CT scan is taken the Haller index is measured. | | | | So Paulo Thoracic Surgery Sector" (PDF). |
| The patient's Haller is calculated by obtaining the ratio | | | | ^ "The Nuss procedure for pectus excavatum |
| of the transverse diameter (the horizontal distance of | | | | correction". Barbara Swoveland, Clare Medrick, Marilyn |
| the inside of the ribcage) and the anteroposterior | | | | Kirsh, Kevin G. Thompson, Nussm Donald. |
| diameter (the shortest distance between the | | | | ^ "Pectus Excavatum overview" (PDF). CIGNA. |
| vertebrae and sternum). A Haller Index of greater than | | | | ^ Ravitch MM (April 1949). "The operative treatment of |
| 3.25 is generally considered severe, while normal chest | | | | pectus excavatum". Ann Surg 129 (4): 42944. |
| has an index of 2.5. The cardiopulmonary tests are | | | | doi:10.1097/00000658-194904000-00002. PMID |
| used to determine the lung capacity and to check for | | | | 17859324. |
| heart murmurs. | | | | ^ Nuss D, Kelly RE Jr, Croitoru DP, Katz ME (April |
| Surgery | | | | 1998). "A 10-year review of a minimally invasive |
| Surgical correction has been shown to repair any | | | | technique for the correction of pectus excavatum". J |
| functional symptoms that may occur in the condition, | | | | Pediatr Surg 33 (4): 54552. doi:10.1016 |
| such as respiratory problems or heart murmurs, | | | | S0022-3468(98)90314-1. PMID 9574749. |
| provided that permanent damage has not already | | | | ^ Pilegaard, HK; Licht PB (February 2008). "Early results |
| arisen from an extremely severe case. | | | | following the Nuss operation for pectus excavatum--a |
| Ravitch technique | | | | single-institution experience of 383 patients". Interactive |
| The Ravitch technique is an invasive surgery that was | | | | Cardiovascular and Thoracic Surgery (Oxford |
| introduced in 1949, and developed in the 1950s to treat | | | | University Press) 7 (1): 5457. doi:10.1510 |
| the condition. This procedure involves creating an | | | | icvts.2007.160937. PMID 17951271. Retrieved |
| incision along the chest through which the cartilage is | | | | 2008-04-18. |
| removed and the sternum detached. A small bar is | | | | ^ Haecker, FM; Mayr J (April 2006). "The vacuum bell |
| then inserted underneath the sternum to hold it up in | | | | for treatment of pectus excavatum: an alternative to |
| the desired position. The bar is left implanted until the | | | | surgical correction?". European Journal of |
| cartilage grows back, typically about 6 months. The | | | | Cardiothoracic Surgery 29 (4): 557561. doi:10.1016 |
| bar is subsequently removed in a simple out-patient | | | | j.ejcts.2006.01.025. PMID 16473516. |
| procedure. The Ravitch technique is not widely | | | | ^ Lahiri, A; Waters R (February 2007). "Experience |
| practiced because it is so invasive. It is often used in | | | | with Bio-Alcamid, a new soft tissue endoprosthesis". |
| older patients, where the sternum has calcified, when | | | | Journal of Plastic, Reconstructive & Aesthetic |
| the deformity is asymmetrical, or when the less | | | | Surgery 60 (6): 663667. doi:10.1016/j.bjps.2006.07.010. |
| invasive Nuss procedure has proven | | | | PMID 17485056. |
| unsuccessful.[citation needed] | | | | ^ "Orthopectus". Dr. Sydney A. Haje, Ortopedista. |
| Nuss procedure | | | | ^ Saour S, Shaaban H, McPhail J, McArthur P |
| Main article: Nuss procedure | | | | (September 2007). "Customised silicone prostheses for |
| Lung exercisers, used after corrective surgery to | | | | the reconstruction of chest wall defects: technique of |
| avoid pneumonia and increase base lung capacity | | | | manufacture and final outcome". J Plast Reconstr |
| X-Ray of a 15 year old male after undergoing the | | | | Aesthet Surg 61: 1205. doi:10.1016/j.bjps.2007.07.019. |
| Nuss procedure | | | | PMID 18178533. Retrieved 2008-08-21. |
| Since then, Dr. Donald Nuss, based at Children's | | | | ^ Wechselberger G, Ohlbauer M, Haslinger J, Schoeller |
| Hospital of The King's Daughters (CHKD) in Norfolk, | | | | T, Bauer T, Piza-Katzer H (November 2001). "Silicone |
| Virginia, has developed a technique that is minimally | | | | implant correction of pectus excavatum". Ann Plast |
| invasive. The Nuss procedure involves slipping in one or | | | | Surg 47 (5): 48993. doi:10.1097 |
| more concave steel bars into the chest, underneath | | | | 00000637-200111000-00003. PMID 11716258. Retrieved |
| the sternum. The bar is flipped to a convex position so | | | | 2008-08-21. |
| as to push outward on the sternum, correcting the | | | | ^ Grappolini S, Fanzio PM, D'Addetta PG, Todde A, |
| deformity. The bar usually stays in the body for about | | | | Infante M (January 2008). "Aesthetic treatment of |
| two years, although many surgeons are now moving | | | | pectus excavatum: a new endoscopic technique using |
| toward leaving them in for up to five years. When the | | | | a porous polyethylene implant". Aesthetic Plast Surg 32 |
| bones have solidified into place, the bar is removed | | | | (1): 10510. doi:10.1007/s00266-007-9025-6. PMID |
| through outpatient surgery. | | | | 17851713. |
| Vacuum bell and Rib compressor | | | | ^ a b Harrison, MR; Estefan-Ventura D, Fechter R et al. |
| Main article: Vacuum bell (medicine) | | | | (January 2007). "Magnetic Mini-Mover Procedure for |
| A relatively new alternative to surgery is the vacuum | | | | pectus excavatum: I. Development, design, and |
| bell. It consists of a bowl shaped device which fits over | | | | simulations for feasibility and safety" (PDF). Journal of |
| the caved-in area; the air is then removed by the use | | | | Pediatric Surgery 42 (1): 8185. doi:10.1016 |
| of a hand pump. The vacuum created by this lifts the | | | | j.jpedsurg.2006.09.042. PMID 17208545. Retrieved |
| sternum upwards, lessening the severity of the | | | | 2008-04-23. |
| deformity. As it is such a recent device there is | | | | ^ "Pectus Excavatum: Frequently Asked Questions: |
| currently no information as to whether it is effective in | | | | Surgery: UI Health Topics". Harold M. Burkhart and Joan |
| the long term. The use of the Rib Compressor along | | | | Ricks-McGillin. |
| with the use of a 7" suction device has proven | | | | ^ "Genetic Anomalies of Cats". |
| effective in permanently correcting pectus excavatum. | | | | ^ Fossum, TW; Boudrieau RJ, Hobson HP, Rudy RL |
| The ribs are compressed while the sternum is lifted by | | | | (1989). "Surgical correction of pectus excavatum, using |
| a small 7" suction device this sets the ribs into the | | | | external splintage in two dogs and a cat". J. Am. Vet. |
| desired position and thus corrects the postition of the | | | | Med. Assoc. 195 (1): 917. PMID 2759902. |
| sternum. | | | | ^ Risselada M, de Rooster H, Liuti T, Polis I, van Bree H |
| Cosmetic and light treatments | | | | (2006). "Use of internal splinting to realign a |
| The cosmetic appearance of pectus excavatum can | | | | noncompliant sternum in a cat with pectus |
| be treated with a dermal filler called Bio-Alcamid. | | | | excavatum". J. Am. Vet. Med. Assoc. 228 (7): 104752. |
| However, as this does nothing to alleviate the actual | | | | doi:10.2460/javma.228.7.1047. PMID 16579783. |
| deformity it will not prevent any physiological | | | | ^ McAnulty JF, Harvey CE (1989). "Repair of pectus |
| symptoms caused by the condition. | | | | excavatum by percutaneous suturing and temporary |
| Mild cases have also reportedly been treated with | | | | external coaptation in a kitten". J. Am. Vet. Med. Assoc. |
| corset-like orthopedic support vests and exercise. | | | | 194 (8): 10657. PMID 2651373. |
| There are also prosthetic implants available to fill the | | | | External links |
| depressed area. Solid silicone implants have been | | | | Wikimedia Commons has media related to: Pectus |
| successfully used for many years with acceptable | | | | excavatum |
| results in some cases. More recently a porex implant | | | | Look up pectus in Wiktionary, the free dictionary. |
| has been used which is a similar material used to | | | | Pectus excavatum at the Open Directory |
| replace skull in brain surgery and severe head injuries. | | | | Projectv d e |
| Magnetic mini-mover procedure | | | | Congenital malformations and deformations of |
| The magnetic mini-mover procedure (3MP) is a | | | | musculoskeletal system / musculoskeletal abnormality |
| technique used to correct pectus excavatum by using | | | | (Q65-Q76, 754-756. |
| two magnets to realign the sternum with the rest of | | | | |