Funnel Chest (Pectus Excavatum)

1. Pectus excavatum, also called funnel chest or cobbler chest, is more common than people think. The degree of deformation varies greatly from person to person, so many people will have it without knowing it. What exactly is pectus, how do you get it and often the most important question is, how do you get rid of it?

What is pectus excavatum

1. In pectus excavatum the sternum is sunken, it is sometimes called funnel chest or cobbler chest. Pectus affects 1 to 8 in 1,000 people and boys have it more often than girls. The chest can be asymmetrical and the sternum can be twisted. The variation in strength is great, for example, one may have only a mild indentation that is not even noticed as pectus excavatum, and another has it so bad that there are only a few centimeters between his / her sternum and spine. Most patients are tall, slender people and in younger children you often see the protruding baby belly for a very long time.

How do you get pectus excavatum

1. It has not yet been proven how this deformation is caused, although it is believed to be due to the excessive growth of the costal cartilage. The cartilages and ribs expand and push the breastbone inward.

Changes deformation with age

1. Parents often do not know when their child is born that it has a deformity, but the moment they find out it appears to be visible for a long time. During the rapid growth it becomes more and more evident. When the age of about 18 years is reached and the growth stops, the malformation remains the same. It will never go away by itself.

Living with pectus excavatum

1. Even in someone with severe malformation, the heart and lungs grow and develop normally. The heart is often moved to the left side of the chest and is somewhat flat in shape. The movement of the heart and lungs is often also limited, so that patients often complain of tightness, shortness of breath and a reduced stamina, especially during exercise. However, there is little recognition for these symptoms, the evidence is not reliable enough.

Are there operations options

1. There are certainly opportunities to improve pectus excavatum.

Nuss Procedure

1. In the 80's this method was developed by Dr. Nuss. One or two bent steel rods (Lorenz's pectus rod) are placed behind the sternum to force it back into its correct shape. The post-operative complications: displacement of the rod.

Leonard's Procedure

1. This procedure is only available in the US. and was developed by Dr. Leonard. A two-sided curvilinear incision under the breasts removes the lower 4-5 cartilages. A wedge is taken from the lower sternum and the chest is repositioned. Wires are tied through the sternum and tied to a plastic support to provide traction. This support is worn for approximately 6 weeks and the correct position is thus secured during healing. Post-operative complications: thread contamination.

Ravitich's procedure

1. Ravitich was the first surgeon to correct a pectus malformation in 1952. The procedure is often modified by a surgeon today. A horizontal or vertical incision is usually made and the pectoral muscles are lifted. The ribcage cartilages that have fused together are cut out and the sternum is rotated to lie flat. Then one or more rods or struts are deployed. Drains are used, drains are drainage channels. The muscles are repaired and the wound closed with dissolvable stitches. The hospital stay can last from 5 days to 3 weeks. Contact such as during sports should be avoided for 3 to 4 months, until all bones have healed. The rods or struts can be removed later. The post-operative complications are the discomfort of the Sternal rod and its scarring.

Silicone implants

1. With a minimal pectus excavatum, silicone implants can be used for camouflage. They are placed under the skin or under the muscles.

My own experiences with pectus excavatum

1. I know so much about pectus excavatum because I was born with it myself. At a young age my parents discovered that my chest fell in sharply. I had the deformity in strong shape where the difference between sternum and ribs was only a few inches. My father's fist fit in my chest, and we always called it my "marble dimple". My swimsuit always sucked in so it was visible and I had a baby belly for a long time. At the age of 9 I was operated on in Groesbeek by a professor because of the degree of deformity. After a few days of intensive care, I arrived in my regular hospital room and was allowed to get out of bed every now and then. Very carefully, I was not allowed to be hit, because I had no rods and struts in place despite the Ravitich method being used. So I could collapse like a plum pudding. Everything went well, and after 3 weeks I was allowed to go home, and the 4 months that followed I had to take it extremely easy. The scar was not too bad, it is horizontal all over my chest, but it is a thin scar. The scars from the drains are thicker and uglier. When I was about 16 years old, however, I got more and more shortness of breath with fog, in a swimming pool, during exercise, etc. People were thinking about asthma, but an asthma pump gave no result. After further investigation it turned out that I therefore suffered from the very rare complication suffocating osteodystrophy, so a band feeling around the rib cage. During exercise, this mainly manifests itself in shortness of breath and muscle acidity. It is fine to live with, but it can sometimes be annoying because you really can't do what someone your age should normally be able to do. It also only became clear when I really got bigger, previously I had little trouble with it. It has not been proven whether pectus is hereditary, but shortly after the birth of my first child, my son, I saw that he also had it. Of course that was a shame and we could only hope that it would not get worse. He is now (2011) 6 years old and fortunately it has not gotten worse, he has a slight deformation so far. My daughter doesn't have it, fortunately she is spared it. But, I know what it is, so who better to help and inform him and others than myself.