Pectus excavatum: Etiology and evaluation
- Oscar H Mayer, MD
Oscar H Mayer, MD
- Associate Professor of Clinical Pediatrics, Pediatric Pulmonology
- University of Pennsylvania School of Medicine
Pectus excavatum (PE), or "funnel chest," is a deformity of the chest wall characterized by a sternal depression typically beginning over the midportion of the manubrium and progressing inward through the xiphoid process (picture 1).
The clinical significance of PE depends on three issues:
●Severity of the chest wall defect
●Psychosocial impact, because the defect alters the patient's appearance
- Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009; 21:44.
- Fonkalsrud EW. 912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon's experience. World J Surg 2009; 33:180.
- Park CH, Kim TH, Haam SJ, Lee S. Rib overgrowth may be a contributing factor for pectus excavatum: Evaluation of prepubertal patients younger than 10years old. J Pediatr Surg 2015; 50:1945.
- Lester CW. The Surgical Treatment of Funnel Chest. Ann Surg 1946; 123:1003.
- Williams AM, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev 2003; 4:237.
- Jones, KL. Smith's recognizable patterns of human malformation. In: New Reference, Elsevier, Philadelphia 2006. p.901.
- Kelly RE Jr. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg 2008; 17:181.
- Leung AK, Hoo JJ. Familial congenital funnel chest. Am J Med Genet 1987; 26:887.
- Creswick HA, Stacey MW, Kelly RE Jr, et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg 2006; 41:1699.
- Kotzot D, Schwabegger AH. Etiology of chest wall deformities--a genetic review for the treating physician. J Pediatr Surg 2009; 44:2004.
- Humphreys GH 2nd, Jaretzki A 3rd. Pectus excavatum. Late results with and without operation. J Thorac Cardiovasc Surg 1980; 80:686.
- Krummel, MT. In: Kendig's Disorders of the Respiratory Tract in Children, 6th ed, WB Saunders 1998. p.287.
- Haller JA Jr, Loughlin GM. Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines. J Cardiovasc Surg (Torino) 2000; 41:125.
- Lacquet LK, Morshuis WJ, Folgering HT. Long-term results after correction of anterior chest wall deformities. J Cardiovasc Surg (Torino) 1998; 39:683.
- CHIN EF. Surgery of funnel chest and congenital sternal prominence. Br J Surg 1957; 44:360.
- Landolfo KP, Sabiston DC. Surgery of the Chest, 6th ed, Sabiston DC, Spencer FC (Eds), WB Saunders, Philadelphia 1995.
- Fonkalsrud EW. Current management of pectus excavatum. World J Surg 2003; 27:502.
- Kelly RE Jr, Cash TF, Shamberger RC, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics 2008; 122:1218.
- Bay V, Farthmann E, Naegele U. Unoperated funnel chest in middle and advances age: evaluation of indications for operation. J Pediatr Surg 1970; 5:606.
- Nuss D, Kelly RE Jr. Minimally invasive surgical correction of chest wall deformities in children (Nuss procedure). Adv Pediatr 2008; 55:395.
- Felts E, Jouve JL, Blondel B, et al. Child pectus excavatum: correction by minimally invasive surgery. Orthop Traumatol Surg Res 2009; 95:190.
- Colombani PM. Preoperative assessment of chest wall deformities. Semin Thorac Cardiovasc Surg 2009; 21:58.
- Saxena AK, Willital GH. Valuable lessons from two decades of pectus repair with the Willital-Hegemann procedure. J Thorac Cardiovasc Surg 2007; 134:871.
- Ravitch MM. The Operative Treatment of Pectus Excavatum. Ann Surg 1949; 129:429.
- Waters P, Welch K, Micheli LJ, et al. Scoliosis in children with pectus excavatum and pectus carinatum. J Pediatr Orthop 1989; 9:551.
- Kelly RE Jr, Shamberger RC, Mellins RB, et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg 2007; 205:205.
- Schaerer D, Virbalas J, Willis E, et al. Pectus excavatum in children with laryngomalacia. Int J Pediatr Otorhinolaryngol 2013; 77:1721.
- Calloway EH, Chhotani AN, Lee YZ, Phillips JD. Three-dimensional computed tomography for evaluation and management of children with complex chest wall anomalies: useful information or just pretty pictures? J Pediatr Surg 2011; 46:640.
- Haller JA Jr, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 1987; 22:904.
- Malek MH, Fonkalsrud EW, Cooper CB. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest 2003; 124:870.
- Lawson ML, Barnes-Eley M, Burke BL, et al. Reliability of a standardized protocol to calculate cross-sectional chest area and severity indices to evaluate pectus excavatum. J Pediatr Surg 2006; 41:1219.
- Kim M, Lee KY, Park HJ, et al. Development of new cardiac deformity indexes for pectus excavatum on computed tomography: feasibility for pre- and post-operative evaluation. Yonsei Med J 2009; 50:385.
- Kim HC, Park HJ, Ham SY, et al. Development of automatized new indices for radiological assessment of chest-wall deformity and its quantitative evaluation. Med Biol Eng Comput 2008; 46:815.
- Marcovici PA, LoSasso BE, Kruk P, Dwek JR. MRI for the evaluation of pectus excavatum. Pediatr Radiol 2011; 41:757.
- Lawson ML, Mellins RB, Tabangin M, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg 2005; 40:174.
- POLGAR G, KOOP CE. PULMONARY FUNCTION IN PECTUS EXCAVATUM. Pediatrics 1963; 32:209.
- Quigley PM, Haller JA Jr, Jelus KL, et al. Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr 1996; 128:638.
- Fonkalsrud EW. Management of pectus chest deformities in female patients. Am J Surg 2004; 187:192.
- Mocchegiani R, Badano L, Lestuzzi C, et al. Relation of right ventricular morphology and function in pectus excavatum to the severity of the chest wall deformity. Am J Cardiol 1995; 76:941.
- Kowalewski J, Brocki M, Dryjanski T, et al. Pectus excavatum: increase of right ventricular systolic, diastolic, and stroke volumes after surgical repair. J Thorac Cardiovasc Surg 1999; 118:87.
- Krueger T, Chassot PG, Christodoulou M, et al. Cardiac function assessed by transesophageal echocardiography during pectus excavatum repair. Ann Thorac Surg 2010; 89:240.
- Sigalet DL, Montgomery M, Harder J. Cardiopulmonary effects of closed repair of pectus excavatum. J Pediatr Surg 2003; 38:380.
- Chao CJ, Jaroszewski DE, Kumar PN, et al. Surgical repair of pectus excavatum relieves right heart chamber compression and improves cardiac output in adult patients--an intraoperative transesophageal echocardiographic study. Am J Surg 2015; 210:1118.
- Malek MH, Berger DE, Marelich WD, et al. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg 2006; 30:637.
- Tardy MM, Filaire M, Patoir A, et al. Exercise Cardiac Output Limitation in Pectus Excavatum. J Am Coll Cardiol 2015; 66:976.
- Borowitz D, Cerny F, Zallen G, et al. Pulmonary function and exercise response in patients with pectus excavatum after Nuss repair. J Pediatr Surg 2003; 38:544.