Fixing Chest Wall Deformities: A Minimally Invasive Option

Fixing Chest Wall Deformities: A Minimally Invasive Option

By Robert L. Weinsheimer, MD
Pediatric General Surgeon

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

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Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves using a curved metal bar tailored to the patient and sliding this into position under the ribs and sternum to correct the defect. A camera is used to safely guide the passage of the bar. The bar is left in place for about 3 years and then a small surgery is required for its removal. I was fortunate enough to learn this procedure from Dr. Nuss along with my adult thoracic colleague, Dr. Farivar. Together we are offering a program to evaluate and treat appropriate patients with this great technique. While this surgery is not necessary for all patients with pectus excavatum, it represents a great option for children and young adults who suffer from any combination of the consequences of this deformity.

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For more information, visit our pectus excavatum repair page.

Comments
Rob Weinsheimer, MD
Dear Bev,
Thank you for your comment. It is the case that the decision to proceed with a Nuss bar is something that shouldn’t be taken lightly. Although it is less invasive than the alternative open procedures, it still requires a great commitment on the part of the patient. We have had many patients competing in athletics at a very high level with the bar in place, but hockey and football are 2 sports in which we typically restrict activities until bar removal. Regarding timing of surgery, the ideal time is before or during the adolescent growth phase, but we have had very good results with adults who are motivated to correct this deformity. We would be happy to see your son if that would be of any help as each situation is unique and requires tailoring therapeutic options to the individual.
3/11/2013 4:49:50 PM
Bev Roggeman
My son is 22 years old with a diagnosis of PE. He is very healthy and on the IU football team as a walk on punter. While home on a visit on 11-16-12 he complained of heartburn a good portion of the day. He is a very healthy eater. I am concerned that his condition is worsening. We saw a pediatric doctor at Riley's Children's hospital when he was 20. He measured an amount that would allow him to have the Nuss Procedure. After watching a video blog my son came across of a Notre Dame student my son's age, it is ANYTHING BUT MINIMALLY INVASIVE as this page suggests and it is more difficult to correct when they are a young adult. Isn't there any new technique to fix this? Perhaps when he was a young teenager if we had known of this procedure we would have done it. Leaving the bar in for 3-5 years is not an option. Most people are not agile enough to move around and function normally with this bar in. Please advise. Thank you.
11/17/2012 12:13:32 PM
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