Pectus excavatum, or sunken chest, is the most common congenital chest wall abnormality in children. Although some medical providers may think that the abnormality is purely a cosmetic problem, the limited chest cavity space can displace the heart as well as limit lung capacity, says Dr. Mustafa Kabeer, a pediatric surgeon at CHOC Children’s. Fifteen percent of patients can experience arrhythmia or mitral valve regurgitation, wherein the heart valves allow blood to leak back into the heart, as a result of the inward compression from the sternum.
Although the cause is unknown, 40 percent of patients report a family history of pectus excavatum, and 40 percent of cases occur in tandem with scoliosis, says Dr. Kabeer.
Parents may notice an indentation in their child’s chest wall either when they are first born, or closer to puberty, when changes in the chest wall can become more pronounced.
Dr. Kabeer urges medical providers to carefully evaluate symptoms, as they can be subtle and often go unnoticed. If a patient is older than 10 years with pectus deformities, he asks medical providers to look for signs of shortness of breath, difficulty breathing during exercise, unexplained dizziness, occasional chest pain or progressing changes in chest wall appearance. Some patients notice they are not able to keep up with their peers. If they show even mild symptoms that were not previously recognized, they should be referred to the pectus excavatum team at CHOC, he explains.
The multidisciplinary team is comprised of experts in pediatric pulmonology, cardiology and surgery. The team performs various testing to examine heart and lung function, before and after surgery that expands the chest wall. By using the latest techniques in minimally invasive surgery that dramatically reduces the appearance of incisions, along with recent improvements in pain management, patients are able to return home and get back to their daily activities sooner than ever before.
“We have a comprehensive team ready to evaluate these patients because chances are high that they have some compromise on the cardiopulmonary system given the compression of the sternum. This is not generally noticeable until they are in some kind of increased activity at which point the increased demand from the body has difficulty being met by the heart and lungs,” Dr. Kabeer says.
“These patients should be referred to pediatric surgeons because we are trained in the minimally invasive procedure and should be the first line approach to this problem; there is no need to put a child through a more invasive operation that is not needed,” he adds.
Dr. Kabeer recommends the following referral guidelines:
- Age < 10 years can be monitored and symptoms and severity of deformity based only on exam should be logged. No studies are necessary at this time unless symptoms are severe at which point, they should be referred to the pectus excavatum team at CHOC, but workup is not necessary prior to referral.
- Age >10 years with very mild pectus deformities and with no symptoms can be referred or observed.
- Age >10 years with pectus deformities that are moderate or severe with or without symptoms and mild deformity with symptoms should be referred to the pectus excavatum team at CHOC. No imaging or workup is necessary until seen by the pediatric surgeon.
To contact Dr. Kabeer, or to refer a patient, please call 714-364-4050.