Know the Risks of Sunken Chest

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.

Dr. Mustafa Kabeer, pediatric surgeon at CHOC Children’s
Dr. Mustafa Kabeer, pediatric surgeon at CHOC Children’s

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.

Learn more about CHOC’s surgical services.

In the Spotlight: CHOC Children’s Specialists Pediatric Surgery

“I would never live in a community that doesn’t have a children’s hospital,” says Dr. Mustafa Kabeer, a CHOC Children’s Specialists pediatric surgeon.

Dr. Kabeer and his three partners – all fathers – firmly believe that ill or injured children require the clinical expertise and compassionate, family-centered care unique to pediatric facilities, like CHOC Children’s.

“Kids aren’t small adults.  From tiny newborns to adult-sized teens, each pediatric patient deserves access to the technology, environment and people that can only be found at a children’s hospital.  Here at CHOC, everything we do – each and every day – is focused on children.  We deliver a high level of care in a friendly setting that promotes collaboration among staff and families,” explains Dr. Kabeer. 

Philosophy of Caring
Together, Dr. Kabeer and his partners, Dr. David Gibbs, Dr. Troy Reyna and Dr. Saeed Awan, abide by a philosophy of care that engenders trust between them and their patients and families. More specifically, they treat their patients like they’d want their own children treated.  Similarly, they treat the parents the way they’d want to be treated.

“We encourage parents to come to us with questions so they can learn as much as possible.  As parents, we would do the same thing if we were in their shoes. They need to do whatever they can to feel like they are being good parents, and we want to partner with them in that effort.  We have the same goal:  getting their kids better,” says Dr. Gibbs.

This commitment is extended to referring physicians.

“Physicians in the community should always feel comfortable contacting us.  We answer their calls directly and get their patients seen promptly.  With telemedicine and additional technological advances, we’re always exploring ways to extend our reach into the community,” says Dr. Reyna. 

Scope of Services
In addition to performing the more common surgeries, such as hernia repair, the group offers minimally invasive surgery, the Nuss procedure (for the repair of Pectus Excavatum), robotic surgery and thoracic surgery.  With the addition of Dr. Reyna, approximately two years ago, and Dr. Awan, about eight months ago, CHOC Children’s Specialists Pediatric Surgery has increased the scope of clinical activities, performing an increasing number of thoracic surgeries and treating more cases of inflammatory bowel disease, for example.

“One of the reasons my colleagues and I chose this specialty is the breadth and depth of our field.  We completed one of the longest pathways in the U.S. medical system to become pediatric surgeons.  This training prepared us to operate in a number of areas, from the neck to the pelvic region.  And these are the areas in which we have performed thousands of surgeries throughout our years of practice.  As a group, we bring this experience – and the rigorous training it took to get here – to our patients and their families,” says Dr. Awan.

Commitment to CHOC
As advocates for their patients and families, as well as the broader medical community, the pediatric surgeons are actively involved at the hospital.

Dr. Gibbs is president of the medical staff and the interim medical director of pediatric trauma. 
Dr. Kabeer has served on the CHOC Children’s board of directors and currently serves as secretary/treasurer of the Pediatric Subspecialty Faculty, Inc. board of directors.  All four physicians are active on various committees and in resident training.  All are involved in CHOC’s surgical neonatal intensive care unit, which they created in partnership with the hospital’s neonatology division.

“We couldn’t imagine being the kind of physicians we strive to be without a deep connection to the hospital.  It’s been very rewarding to be a part of CHOC’s recent evolution, which gives us a greater ability to care for our kids,” says Dr. Kabeer.

With a primary office in Orange, CHOC Children’s Specialists Pediatric Surgery has offices in Corona, Mission Viejo and Newport Beach. To refer a patient, please call 714-364-4050.