What are indications for surgical repair of pectus excavatum?

Updated: Oct 30, 2018
  • Author: Andre Hebra, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Answer

Operative correction should be considered in patients who present with pectus excavatum and cardiopulmonary impairment. The correction index provides an accurate assessment of pectus severity, and by the nature of the measurement, it reflects the potential degree of operative repair. The Haller index correlates well with the correction index in pectus patients with standard chest wall dimensions, but it is quite discrepant in the nonstandard chest. [11] The most common goal in operative repair of pectus excavatum is to correct the chest deformity. This is particularly important in teenagers, in whom the appearance of the chest can result in significant problems related to body image and self-esteem. Thus, the desire to improve the appearance of the chest is considered an appropriate medical indication for surgery. The images below illustrate the dramatic appearance of pectus excavatum in young male and female patients.

A 16-year-old boy with severe pectus excavatum. No A 16-year-old boy with severe pectus excavatum. Note the appearance of the caved-in sternum and lower ribs.
A 10-year-old girl with severe pectus excavatum. I A 10-year-old girl with severe pectus excavatum. In girls, the deformity is of particular concern because of the medial displacement of the breast, resulting in significant asymmetry of the breasts and nipples (cross-eyed appearance of the nipples).
A 10-year-old girl with severe pectus excavatum. N A 10-year-old girl with severe pectus excavatum. Note the significant asymmetry of the breasts and nipples (cross-eyed appearance of the nipples).

Other indications include exercise and physical activity limitations, evidence of cardiac or pulmonary dysfunction, chest pain, psychological distress, and potential future need for sternotomy (open-heart surgery). Adult patients with pectus excavatum who undergo open-heart surgery typically have significant displacement and rotation of the heart to the left chest. This can make the operative approach to the heart at the time of open-heart surgery difficult and challenging. With this in mind, elective repair of the pectus deformity prior to open-heart surgery may be indicated in selected cases.


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