Common Thoracic Problem

Pectus Excavatum

Pectus Excavatum (funnel chest)- a common chest wall deformity.

It is caused by congenital disorder of rib cartilage. It affects people of all ages. The depression is related to the overgrowth of cartilage in an inwards direction causing compression and displacement of the heart and lungs.

3 in 1000 live born infants have this deformity and depression tends to be more prominent at growth spurt.

Gradual compression of heart usually allows the heart to adapt and avoid significant hemodynamic effect. But overall exercise tolerance is usually impaired.

In early and late adulthood, symptomatic breathing and exercise limitation occur despite not truly measurable in laboratory's cardio- respiratory assessment.

Associated psychosocial impact is great. Introvert and timid personality is usual  with related behavioral change to hide oneself or to minimise the body exposure such as avoid swimming.

Pain in shoulder and chest is another common complaint.

Other skeletal abnormality such as kypho-scoliosis, breast asymmetry and sternal cleft can occur but treatment for these are separate consideration.

Underlying causes - majority are unknown. Rarely Ricket or severe broncho
obstruction causes abnormal cartilage growth

Treatment of Funnel chest:

Non operative:

  1. Wearing of brace is not useful but some modification of suction device or magnet device coupled with wearing of specifically made garment can alleviate the deterioration

  2. Physiotherapy and posture correction can prevent secondary effect

  3. No treatment - a bad and unacceptable option nowadays

Operative:

  1. Traditional approach

    Excision of cartilage and wedge osteotomy of sternum (the Ravitch operation)

  2. Walda operation

    Turn over of chest wall anterior part with potential XXXXX XXXXXX

  3. New non destructive operation

    insertion of metal bar as internal brace to correct cartilage ribcage configuration, i.e. Nuss procedure

Operative risks are definite but minimal in experienced hands.  Mortality is virtually zero nowadays. Nuss procedure is fast, effective and near guarantee result except in rare extreme asymmetric deformed chest.
Main side effect are pain, displacement of bar, and metal allergy or soft tissue wound infection.

In Hong Kong selected private hospital the procedure is available and done by experienced surgeon and satisfactory result are expected.  The best result is achieved if operation can be done before puberty (8-13 years of age today HK).