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Pectus excavatum is the most frequently observed type of chest malformation in children. The condition is also known as “Funnel chest” or “Sunken chest”. It’s a chest wall deformity involving multiple ribs and the breastbone growing inwards. That gives the chest a concave appearance that looks sunken or caved-in.
What is Pectus Excavatum?
It’s a genetic condition that can be passed down through heredity. About 40% of children diagnosed with the condition report having one or more relatives with the condition. 
Pectus excavatum is observed more commonly in males and isn’t always visible upon birth. The condition becomes more evident as the child grows, with the inwards curvature becoming more pronounced.
The deformity can range from mildly odd-looking to a severely sunken chest. Causes for Pectus excavatum are not entirely understood. During normal development, the ribs and breastbone grow outward at the anterior of the chest. 
Pectus excavatum is believed to result from abnormal growth of the cartilage that connects the ribs to the sternum. This excessive growth pulls the sternum inward, resulting in pectus excavatum.
Often, children diagnosed with pectus excavatum also suffer from one or more of the following conditions:

  • Scoliosis: a spinal curvature disorder in which the spine curves incorrectly
  • Rickets: a vitamin D or calcium deficiency marked by fragile and brittle bones
  • Marfan syndrome: a congenital disorder that affects the connective tissue of the heart, eyes, skeleton, and blood vessel networks
  • Poland syndrome: another congenital disability that causes underdeveloped, weak, or absent muscles. Usually on either side of the body

Even though it’s a birth defect, signs and symptoms of pectus excavatum typically appear as the child nears puberty. Mild cases only present with a slight dip in the chest wall that’s barely obvious. A child may not show any symptoms during normal daily activities but get tired and out of breath quicker than his peers. 
In more extreme cases, pectus excavatum can create pressure on the lung and heart. That could compromise the working of vital functions, leading to a host of other issues such as

  • Chest pain
  • Shortness of breath
  • Coughing or wheezing.
  • Low threshold for fatigue
  • Faster than normal heartbeat.
  • Frequent respiratory infections
  • Heart murmur, in severe cases
  • Inability to perform activities or participate in vigorous sports

The diagnostic process will depend on your child’s overall health and the presence of other defects. The doctor will perform a physical exam and might recommend one or more of the following tests if pectus excavatum is suspected

  • Chest X-ray
  • CT-scan
  • ECG or EKG [Electrocardiogram]
  • Auscultation: an analysis of heart and chest sounds to measure the impact of the deformity on cardiopulmonary function.
  • Echocardiogram (a noninvasive test that takes a picture of the heart with sound waves)
  • Pulmonary function testing: performed by breathing into an instrument that measures the amount of air inhaled over a certain period of time
  • Haller Index: performed to determine the severity of pectus excavatum in a specific case. Measurements are extracted from a CT scan for calculation. A Haller Index of greater than 3.25 is generally considered severe (a normal Haller Index is 2.5).

Treatment Options
Children’s bodies are constantly developing and growing, each unique from the other. That’s why when it comes to pectus excavatum, pediatricians often take the “wait and see” approach. Given, of course, that the deformity is not affecting cardiopulmonary function.
Complications from pectus excavatum can vary widely from infants to teenagers. That’s why it’s crucial to regularly monitor any suspected cases before symptoms develop into any severe complications. 
Scheduling regular appointments with a specialist is a great preventive measure for all children diagnosed with the condition.
Pectus excavatum can be surgically treated if symptoms prevail to improve a patient’s breathing and cardiac function. That’s done by repositioning the sternum to a more natural, outward position. Once the breast bone is not bending inwards, pressure on the heart and lungs eases up. That allows enough room for the organs to function more effectively.
Of course, addressing any psychological aspects of the condition is also important. Pectus excavatum often peaks when children are approaching puberty and already going through many challenges regarding their self-image. Surgery is less invasive in most cases and dramatically improves the physical appearance of the chest.
Surgical options available to your child will vary on several factors. Primarily these procedures are performed for correcting pectus excavatum:
The Nuss Procedure
A camera is guided through the chest cavity, and two small slits are made on each side of the chest. The next step is to insert an arched steel bar just under the sternum.
The curvature of these steel bars is modified for each patient, depending on their deformity. It can be left in place for up to 3 years while it slowly reshapes the chest depression.
The Ravitch Procedure
This is the more traditional and invasive surgical option for correcting pectus excavatum. It can take any of these two approaches:
An incision is made on the front of the chest, and cartilaginous parts of the overgrown ribs are cut and removed. The sternum is then pulled forward, away from the heart and lungs, and into the natural plane of the chest wall. A metal plate and screws then securely adhere the sternum into its new position.
With the second method, a small metal bar is placed behind the sternum. It’s left in place from 6 months up to a year. Removal of the bar is done in a simple outpatient procedure once the chest takes on a more normal appearance.
Vacuum Bell Device
An effective way to treat milder pectus excavatum in young patients. A bell-shaped instrument connected to a pump is placed on the child’s chest. It pumps the air out, creating a vacuum that brings the chest forward.
Doctors often recommend physical therapy and exercises in addition to all these correctional methods. The goal is to strengthen the chest muscles and improve your child’s posture.
Help Your Child Overcome Pectus Excavatum
If you suspect pectus excavatum in your child, the best time to take action is now. Book a free consultation today with Align clinic to discuss treatment options to correct and manage the condition.