Congenital Chest Deformities

Chest deformities are congenital abnormalities in bone and muscle structure of chest wall. Most of these disorders, ranging from a slightly protruding rib cage to the heart wholly protruding outside the rib cage (which is deadly), are not life-threatening; they either do not cause any nuisance or only lead to some complaints due to restriction of functions. Although there are various deformities, the most frequent chest deformities are Pectus Excavatum (cobbler’s chest) and Pectus Carinatum (pigeon’s chest).

Pectus Excavatum:It is also known as cobbler’s chest. Front chest wall is sunken in. It usually occurs at birth or in the first years of life. It becomes more distinct during fast growth years at 14-15 years of age. It is the most common chest wall deformity. It is seen 4 times higher in men than in women.

Most Frequent Complaints

• Negative psychological effects due to impaired physical appearance
• “Decreased exercise capacity” due to impaired heart and lung functions and therefore, having difficulties in sport activities when compared to peers.

Treatment

Treatment is usually surgical. Although ideal surgery time depends on the sex, individual patient and deformity, it is averagely 10-12 years of age. Vacuum bell can be used in mild cases or to facilitate the surgery of severe cases. A suitable pectus bar (steel bar) is determined by necessary measurements before the surgery and inserted surgically. Most of the patients return to school within 2-3 weeks albeit with six weeks long exercise restrictions (physical training, heavy lifting). Pectus bar is removed 2-4 years after insertion. Removal procedure is conducted under general anesthesia. No significant complication has been reported during the removal of bars. Patients can be discharged one to two hours after removal of bars. Long-term results of NUSS surgeries demonstrate that recurrence risk is below 5% and patient satisfaction is quite high.

NUSS Surgery

It is a surgical method necessitating fewer incisions to remove Pectus Excavatum (Cobbler’s chest), requiring fewer procedures and procedure time, providing quick post-operative recovery and more positive long-term results. It is a procedure performed by video-assisted thoracoscopy by supporting the back of breastbone (sternum) with a bar (steel bar) and elevating it anteriorly. Since no cut or division is required in ribs and cartilages, a large incision on the chest wall is not necessary. Cobbler’s chest should be corrected before adolescence if possible, thus the rib cage can take its normal shape at the end of this fast growth period. However, with NUSS technique, very good results can be obtained in patients in their 30s and 40s as well.

Pectus Carinatum: In this disorder which is also called as pigeon chest, frontal chest area protrudes forward. Complaints are the same as those in excavatum. Pectus carinatum disorder can be corrected by a closed surgical method called ABRAMSON which is similar to NUSS surgery.

Abramson surgery: No intrusion into the thoracic cavity is required in this technique. Steel bar is given the appropriate shape and passed through a tunnel prepared subcutaneously in the level the chest protrudes most. Both ends of the bar are secured to the fixation plates called stabilizers and fixed on ribs with steel wires. This steel bar and stabilizers are removed after 2-4 years under general anesthesia.