Pediatric Surgery & Anesthesiology
Chest Wall Deformity Center of Excellence
Chest wall deformities, including pectus excavatum (sunken chest) and its opposite, pectus carinatum (protruding chest), affect one in 400 children or teens.
The Chest Wall Deformity Center of Excellence at Miami Children’s Hospital is Florida’s leader in the assessment and treatment of chest wall problems, and is the only center in the state offering comprehensive treatment for the more rare pectus carinatum.
In addition to congenital deformities, the center also provides care for children and teens with chest irregularities occurring as a result of cancer surgery.
Miami Children’s Hospital has long been a leader in treatment of chest wall deformities. Over the decades, hundreds of patients have enjoyed the physiologic and esthetic benefits of chest remodelling. In 1997, the surgeons here were the first in the Southeast to perform the minimally invasive Nuss repair for pectus excavatum.
Pectus excavatum, Latin for “hollowed chest,” is the most common chest wall deformity. It may also be referred to as sunken chest, hollow chest, or concave chest. This condition is characterized by a distinctly depressed sternum (breastbone), which in some patients is evident at birth, and for others develops later, typically during adolescence. In severe cases, pectus excavatum can affect the heart and lungs, while less severe cases often impact a child’s or teen’s self-image.
Patients with pectus excavatum may experience shortness of breath, chest pain, and exercise intolerance. Surgery may be necessary to relieve discomfort and prevent heart and breathing abnormalities.
Physicians at the Chest Wall Deformity Center use computed tomography (CT) scans to image the internal structures of the chest to assess the severity of the depression. They may also arrange for pulmonary function and cardiac evaluations to determine the impact of the deformity on each individual.
The Haller index (dividing the width of the rib cage by the distance from the sternum to the spine) is often used to evaluate the severity of pectus excavatum. A normal index is about 2.5, while an index greater than 3.25 may be severe enough to indicate surgical correction.
Surgical Treatment Options:
The Chest Wall Deformity Center offers both traditional surgical treatments as well as minimally-invasive operations for pectus excavatum. Options are reviewed and a course of treatment is selected with input from the family, based on the severity and asymmetry of the defect. Operative repair is customized to best correct the specific condition noted in each patient.
The Ravitch procedure, developed in the 1940s, is a technique that involves opening the chest cavity. With this technique, small sections of rib cartilage are removed, and the sternum is raised. Metal bars, called struts, may be implanted to hold the chest wall in place to reshape the chest. These may then be removed about six months after the operation.
The Nuss procedure, developed in the 1980s, is a minimally invasive procedure. With this technique, a small incision is created under each armpit, with a third tiny incision made for insertion of a thin camera. The camera guides the surgeon in implanting a curved metal bar under the sternum allowing immediate correction of the sunken appearance of the chest. These bars may be removed after several years, once the new bone structure is established.
Pectus carinatum, also known as pigeon chest, is a deformity in which the sternum (breastbone) and ribs protrude. Other names are chest protrusion, protruding chest or protruding sternum. The condition may be caused by excessive growth of cartilage. Pectus carinatum can be present at birth, although it can also occur during adolescence, emerging suddenly during the growth spurt at puberty. The condition can be associated with certain genetic disorders or syndromes, and sometimes arises following open heart surgeries in which the sternum is split.
Pretreatment assessment may include physician evaluation, photos and measurements of the chest wall.
The Chest Wall Deformity Center of Excellence at Miami Children’s Hospital is the only facility in Florida to offer an FDA-approved bracing treatment for pectus carinatum in addition to comprehensive surgical options for children and teens.
Chest bracing therapy is a nonsurgical method that utilizes a customized chest-wall brace, custom built for the specifics of each patient, to reduce the chest protrusion over time. The brace is worn under clothing and, in combination with an exercise program, may completely correct the problem. The duration of bracing depends on the type and severity of the protrusion, but most defects typically respond well with six to eight months of treatment.
Surgical Treatment Options:
Surgery may be suggested for for some patients with moderate to severe pectus carinatum, as well as those who cannot tolerate bracing.
The Ravitch technique, developed in the 1940s, is similar to the procedure developed for pectus excavatum and involves opening the chest wall. With this technique, small sections of rib cartilage are removed. The sternum is then flattened, with correction noted immediately after surgery.
To contact the Chest Wall Deformity Center of Excellence at Miami Children's Hospital, please call 786-624-4191.