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Pectus Excavatum/Carinatum

  • • Often present at birth but becomes more pronounced as adolescence progresses

    • Excavatum can be associated with Marfan syndrome and scoliosis

Epidemiology

  • • Males more commonly affected than females

Symptoms and Signs

  • • Excavatum: Posterior curve of sternum with right side usually more curved

    • Carinatum: Protruding sternum

  • • Evaluate for underlying pulmonary or cardiac dysfunction

  • • Physical exam

Surgery

  • • Excavatum: Early and middle teenage years (osteotomy or Nuss bar placement)

    • Carinatum: Osteotomy and sternal fracture

Indications

  • • Severity of deformity and psychosocial impact

Complications

  • • Pneumothorax

    • Injury to great vessels or heart (rare)

    • Recurrence (5-15% with osteotomy repair)

Prognosis

  • • Recurrence rate of 5-15%

References

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Fonkalsrud EW, Beanes S: Surgical management of pectus carinatum: 30 years’ experience. World J Surg 2001;25:898.  [PubMed: 11572031]
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Harrison MR et al: Magnetic mini-mover procedure for pectus excavatum I: development, design, and simulations for feasibility and safety. J Pediatr Surg 2007;42:81.  [PubMed: 17208545]
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Kravarusic D et al: The Calgary protocol for bracing of pectus carinatum: a preliminary report. J Pediatr Surg 2006;41:923.  [PubMed: 16677884]
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Miller KA et al: Minimally invasive repair of pectus excavatum: a single institution’s experience. Surgery 2001;130:652.  [PubMed: 11602896]

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