Review ArticleClinical Review

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Dawn Jaroszewski, David Notrica, Lisa McMahon, D. Eric Steidley and Claude Deschamps
The Journal of the American Board of Family Medicine March 2010, 23 (2) 230-239; DOI: https://doi.org/10.3122/jabfm.2010.02.090234

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Patient with a more focal classic “cup-shaped” or “bowl-shaped” pectus excavatum deformity.

  • Figure 2.
    Figure 2.

    A: Patient exhibiting a broad, more extensive pectus excavatum deformity. B: Patient with Marfan's syndrome and extensive pectus excavatum deformity.

  • Figure 3.
    Figure 3.

    Computerized tomographic scans of the chest showing left-sided heart displacement (A) and right ventricular compression (B) by severe pectus excavatum deformity.

  • Figure 4.
    Figure 4.

    Cardiopulmonary exercise testing VO2/heart rate study from a symptomatic PE patient before (A) and after (B) operation.

  • Figure 5.
    Figure 5.

    Cardiopulmonary exercise testing VO2/CO2 study from a symptomatic PE patient, before (A) and after (B) operation.

  • Figure 6.
    Figure 6.

    Schematic diagrams (A) and operative photographs (B and C) depicting the modified Ravitch procedure.

  • Figure 7.
    Figure 7.

    A: Schematic drawing showing position of support bar with the Nuss procedure. B: Chest roentograph showing 2 sternal support bars after repair with the Nuss procedure. Photographs before (C) and after (D) the operation of a patient with pectus excavatum undergoing minimally invasive Nuss repair. Lateral incisions are used to place the support bar.

Tables

  • Table 1.

    Most Frequent Symptoms of Pectus Excavatum Noted by Patients

    1. Dyspnea with mild exercise

    2. Progressive loss of endurance

    3. Inability to keep up with peers

    4. Chest pain with activity

    5. Worsening, progressive fatigue

    6. Palpitations

    7. Tachycardia

    8. Exercise induced wheezing

    9. Frequent upper respiratory infections

    10. Easy fatigue

    11. Fainting/dizziness

    12. Chest pain without exercise

    13. Exercise intolerance

  • Table 2.

    Criteria for Surgical Referral

    1. Symptomatic

    2. Progression of the deformity

    3. Paradoxical movement of the chest wall with deep inspiration

    4. Computed tomograph with severity index >3.0

    5. Cardiac compression or displacement

    6. Pulmonary compression

    7. Abnormal pulmonary function studies showing significant restrictive disease

    8. Mitral valve prolapse

    9. Any cardiac pathology secondary to compression of the heart

    10. Significant body image disturbance

    11. History of failed previous repair

    12. Abnormal cardiopulmonary testing

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