Pectus excavatum

Pectus excavatum, also referred to as “sunken chest,” is a depression in the chest wall. The depression may be in the center of the chest or more pronounced on one side. A child can be born with pectus or develop their pectus during their pubertal growth spurt. The pectus may become more severe or apparent during periods of rapid growth. Early evaluation by a pediatric surgeon during the pre-pubertal period is helpful for families to gain an understanding of what to expect as your child matures and when intervention is optimal.

Pectus excavatum

Evaluation

At the Stanford Children’s Health Chest Wall Clinic, your child will meet with our team as we obtain a complete history and physical exam. We may then recommend additional diagnostic testing to best prepare your child for the most appropriate intervention that fits his/her individual needs.  These diagnostic tests may include the following:

  • X-Ray, MRI or CT scan of the chest
  • In-office 3D imaging of the chest wall
  • Cardiac echocardiogram
  • Pulmonary function testing
  • Allergy patch testing

Once the work-up is complete, we will review with you the best options for your child. These options are discussed below.

Treatment

Vacuum Bell
Mild to moderate pectus excavatum may be improved by a focused exercise regimen and/or a vacuum bell approach. The vacuum bell is a non-surgical treatment option for patients with mild or moderate pectus excavatum. While this procedure is non-surgical, it should be used under the supervision of our care team. The vacuum bell is fitted to each patient to sit comfortably on the chest. A bulb attached to the device generates negative pressure to create a vacuum, which raises the sternum over time.  The vacuum bell must be applied at regular intervals, eventually up to 2 hours each session twice daily. The vacuum slowly pulls up the depressed area of cartilage. It may take several months of use to reach the maximum correction. It may require up to two years of regular use ensure a durable correction.

Nuss Procedure
The most commonly performed surgical treatment for pectus excavatum is the “Nuss Procedure.” This is a minimally invasive surgical procedure. During this procedure, small incisions are made on each side of the chest to allow the surgeon to insert a metal support bar underneath the sternum to reverse the depression in the chest. Minimally invasive surgical techniques result in reduced blood loss and shorter operating times that lead to a smoother, faster recovery. The bar is typically left in place for 2-4 years. Early bar removal can result in recurrence of the depression.

Nuss Procedure

Bar Removal  
The bar is generally removed between two to four years after the procedure and can be completed on an outpatient basis under general anesthesia.