Pectus excavatum from a pediatric surgeon’s perspective

Abstract

Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen. We recommend surgical repair at around 12-14 years of age since the chest wall is still typically flexible and because this allows us to keep the bar in place as the patient progresses through puberty which may help decrease growth-related recurrences. Patients with mild to moderate PE are treated with therapeutic deep breathing, posturing, and aerobic exercises, and in appropriately selected patients, the vacuum bell may also be offered. Patients that have severe symptomatic PE are offered Minimally Invasive Repair of Pectus Excavatum (MIRPE). The surgical technique in children is similarto that of adults, except for the higher forces involved that often necessitate sternal elevation and more involved stabilization strategies. Postoperative management includes pain control, deep breathing, and early ambulation. Exercise restriction is mandatory for the first six weeks with slow resumption of normal activity after 12 weeks.

Caso clínico-radiológico pediátrico

“…Actualmente se prefieren los procedimientos mínimamente invasivos siendo la técnica de Nuss la más utilizada 2,6 , que consiste en la introducción de una barra metálica retroesternal, mediante videotoracoscopía. bibliografía…”

Advantages of Cardiac Magnetic Resonance Imaging for Severe Pectus Excavatum Assessment in Children

“…[1][2][3] Although historically PE was thought to be congenital, it rarely presents in the first decade of life. 4 Around 40% of the patients have a positive family history, and it is also seen in association to certain genetic syndromes. [4][5][6] The deformity can be found as early as the first year of life, and it tends to slowly progress, with distinct worsening with puberty and growth spurts.…”

“…4 Around 40% of the patients have a positive family history, and it is also seen in association to certain genetic syndromes. [4][5][6] The deformity can be found as early as the first year of life, and it tends to slowly progress, with distinct worsening with puberty and growth spurts. 2,3 The actual physiologic implications of a sternum impingement on lung and heart function have been debated over the years.…”

Initial experience with a 3D printed model for preoperative simulation of the Nuss procedure for pectus excavatum

“…Further technical developments have occurred after the initial experience in 1987, and the frequency of bar displacement has decreased (4,5). However, there are still some complications, such as over-correction, recurrence, bar allergy, and wound infection (6). In particular, overcorrection and recurrence are considered to be partially the result of technical issues.…”