History of pectus excavatum1

Pectus excavatum was first recognized in the 1500’s. It was not until the early 20th century that thoracic surgery became a widely accepted discipline and it was in 1911 that the first surgical correction of pectus excavatum was attempted by Ludwig Meyer.

In the 1920s, a German surgeon named Ferdinand Sauerbruch performed the first pectus repair using a more aggressive technique. Dr. Sauerbruch removed cartilage from both sides of the chest and a cut was made in the breastbone to correct its shape. This technique was revised and popularized by Dr. Mark Ravitch who, in 1947, published his experience with eight patients using this extended modification of Saurebruch’s technique. Since the sternum was removed from all of its attachments, Ravitch believed the sternum would no longer sink back into the chest and eliminated the use of external traction. As a result, in 1956 Wallgren and Sulamaa introduced the concept of internal support by use of a slightly curved stainless steel bar, a bridge-like technique that created a gap between the chest bone and ribs. In 1961, Adkins and Blades took this concept of internal bracing and invented a stainless steel bar that would pass behind the sternum rather than through it; this form of pectus repair became the technique for patients of all ages for the next 40 years.

In 1986, Dr. Haller drew attention to the flexibility of rib cartilage and questioned its removal. He decided to operate on his next patient by not removing the skin and muscles off of the chest and kept the rib cartilage and sternum in place.  His surgical technique without cartilage resection was the first real alternative to the Ravitch procedure.

In 1997, Dr. Donald Nuss, in cooperation with Walter Lorenz Surgical (Zimmer Biomet), developed a less invasive surgical technique and the Pectus Support Bar implant to remodel the chest wall over a two- to three-year period. This procedure, also known as the Nuss procedure, has shown strong success in patients, with a number of papers presented at national and international meetings8,9,10. This minimally invasive technique has impacted the lives of thousands of patients around the world.

Sunken chest

What is pectus excavatum?

Pectus excavatum is a congenital chest deformity caused by abnormal growth of the cartilage that holds the ribs to the breastbone (sternum). The breastbone is pushed inward creating a condition in which a person’s breastbone is sunken into his or her chest. Sometimes referred to as “funnel chest” or “sunken chest,” the condition seems as though the lower half of the breastbone has been scooped out, therefore leaving a dent.5

Pectus excavatum is typically present at birth and can become more severe as a child gets older, especially during growth spurts in adolescent years, though that is not always the case.6

Severe cases of pectus excavatum may interfere with the function of the heart and lungs, but also may play a part in a child’s self-esteem.9

How common is pectus excavatum and what causes it?

1outofevery300_400

Pectus excavatum occurs in approximately 1 out of every 300 to 400 births, making it one of the most common chest wall deformities. Males are three times more likely to have the condition than females.4

The causes of pectus excavatum are not well understood; however, researchers believe that there may be a hereditary link, as well as an association with certain cartilage disorders, such as Marfan Syndrome.5

While the depression in the chest is noticeable, sometimes pectus excavatum does not cause any symptoms. However, symptoms can occur when the condition applies pressure to the heart and lungs.

A healthcare provider should be consulted if any of the following symptoms are experienced:

  • Chest pain
  • Constant fatigue
  • Shortness of breath
  • Rapid heartbeat

What are the common physical symptoms of pectus excavatum?6

2

While the depression in the chest is noticeable, sometimes pectus excavatum does not cause any symptoms. However, symptoms can occur when the condition applies pressure to the heart and lungs.

A healthcare provider should be consulted if any of the following symptoms are experienced:

  • Chest pain
  • Constant fatigue
  • Shortness of breath
  • Rapid heartbeat

Various psychological effects should not be overlooked and should be treated with the same care as are the physical symptoms.7

  • Depression
  • Feelings of embarrassment
  • Social anxiety
  • Frustration and anger

Patient Education Materials

Patient Guide to Recovery After Pectus Surgery

Find A Doctor

Information & Resources

FAQ for Pectus

What is the Pectus Bar?

  1. http://www.chkd.org/Our-Services/Nuss-Procedure/History-of-Pectus-Excavatum-Treatment/
  2. https://www.mayoclinic.org/diseases-conditions/pectus-excavatum/symptoms-causes/syc-20355483
  3. http://chkd-nuss.org/pectus-excavatum/
  4. http://www.sciencedirect.com/science/article/pii/S1769721214001025
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029481/
  6. https://medlineplus.gov/ency/article/003320.htm
  7. http://pectusexcavatuminfo.com/psychological-effects-pectus-excavatum/
  8. Nuss, D., Kelly, R. E., Croitoru, D. P., & Katz, M. E. (1998). A 10-year review of a minimally invasive technique for the .correction of pectus excavatum. Journal of pediatric surgery, 33(4), 545-552.
  9. Nuss, D., & Kelly, R. E. (2014). The Minimally Invasive Repair of Pectus Excavatum. Operative Techniques in Thoracic and Cardiovascular Surgery, 19(3), 324-347.
  10. Nuss, D., Obermeyer, R. J., & Kelly, R. E. (2016). Nuss bar procedure: past, present and future. Annals of cardiothoracic surgery, 5(5), 422.

 

 

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