Pectus Excavatum Medication

  • Author: Andre Hebra, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: May 1, 2012
 
 

Medication Summary

As mentioned above, no effective drug therapy is available for the treatment of pectus excavatum. See Surgical Care.

Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Girish D Sharma, MD  Professor of Pediatrics, Rush Medical College; Senior Attending, Department of Pediatrics, Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush University Medical Center

Girish D Sharma, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Heidi Connolly, MD  Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center; Professor of Clinical Pediatrics, State University of New York at Stony Brook

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References

  1. Kelly R, Shamberger R, Hebra A, et al. Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection. J Am Col Sur. 2007;205:205-16. [Medline].

  2. Cahill JL, Lees GM, Robertson HT. A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. J Pediatr Surg. Aug 1984;19(4):430-3. [Medline].

  3. Weg JG, Krumholz RA, Harkleroad LE. Pulmonary dysfunction in pectus excavatum. Am Rev Respir Dis. Nov 1967;96(5):936-45. [Medline].

  4. Quigley PM, Haller JA, Jelus KL, et al. Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr. May 1996;128(5 Pt 1):638-43. [Medline].

  5. Peterson RJ, Young WG, Godwin JD, et al. Noninvasive assessment of exercise cardiac function before and after pectus excavatum repair. J Thorac Cardiovasc Surg. Aug 1985;90(2):251-60. [Medline].

  6. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg. 1949;122:429-444.

  7. Nuss D, Kelly RE Jr, Croitoru DP. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. Apr 1998;33(4):545-52. [Medline].

  8. [Guideline] Hebra A. Minimally invasive repair of pectus excavatum. Semin Thorac Cardiovasc Surg. Spring 2009;21(1):76-84. [Medline].

  9. Hebra A. Minimally invasive repair of pectus excavatum. Semin Thorac Cardiovasc Surg. Spring 2009;21(1):76-84. [Medline].

  10. Robicsek F, Hebra A. To Nuss or not to Nuss? Two opposing views. Semin Thorac Cardiovasc Surg. 2009;21(1):85-8. [Medline].

  11. Nuss D. Recent experiences with minimally invasive pectus excavatum repair "Nuss procedure". Jpn J Thorac Cardiovasc Surg. Jul 2005;53(7):338-44. [Medline].

  12. Hebra A. Minimally invasive pectus surgery. Chest Surg Clin N Am. May 2000;10(2):329-39, vii. [Medline].

  13. Becmeur F, Ferreira CG, Haecker FM, Schneider A, Lacreuse I. Pectus excavatum repair according to Nuss: is it safe to place a retrosternal bar by a transpleural approach, under thoracoscopic vision?. J Laparoendosc Adv Surg Tech A. Oct 2011;21(8):757-61. [Medline].

  14. Daunt SW, Cohen JH, Miller SF. Age-related normal ranges for the Haller index in children. Pediatr Radiol. Apr 2004;34(4):326-30. [Medline].

  15. Fefferman NR, Pinkney LP. Imaging evaluation of chest wall disorders in children. Radiol Clin North Am. Mar 2005;43(2):355-70. [Medline].

  16. Fonkalsrud EW, Bustorff-Silva J. Repair of pectus excavatum and carinatum in adults. Am J Surg. Feb 1999;177(2):121-4. [Medline].

  17. Frick SL. Scoliosis in children with anterior chest wall deformities. Chest Surg Clin N Am. May 2000;10(2):427-36. [Medline].

  18. Goretsky MJ, Kelly RE, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin. Oct 2004;15(3):455-71. [Medline].

  19. Grimes SJ, Acheson LS, Matthews AL, Wiesner GL. Clinical consult: Marfan syndrome. Prim Care. Sep 2004;31(3):739-42, xii. [Medline].

  20. Haje SA. Common questions and answers to pectus deformities. Available at http://www.orthopectus.com.br/ffaq.htm. Accessed 2006.

  21. Haller JA Jr, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. Oct 1987;22(10):904-6. [Medline].

  22. Haller JA, Colombani PM, Humphries CT, et al. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann Thorac Surg. Jun 1996;61(6):1618-24; discussion 1625. [Medline].

  23. Haller JA, Scherer LR, Turner CS, Colombani PM. Evolving management of pectus excavatum based on a single institutional experience of 664 patients. Ann Surg. May 1989;209(5):578-82; discussion 582-3. [Medline].

  24. Hebra A, Jacobs JP, Feliz A, Arenas J. Minimally invasive repair of pectus excavatum in adult patients. Am Surg. Sep 2006;72(9):837-842. [Medline].

  25. Hebra A, Swoveland B, Egbert M, et al. Outcome analysis of minimally invasive repair of pectus excavatum: review of 251 cases. J Pediatr Surg. Feb 2000;35(2):252-7; discussion 257-8. [Medline].

  26. Kelly RE, Goretsky MJ, Obermeyer R, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. Dec 2010;252(6):1072-81. [Medline].

  27. Lawson ML, Mellins RB, Paulson JF, et al. Increasing severity of pectus excavatum is associated with reduced pulmonary function. J Pediatr. Aug 2011;159(2):256-61.e2. [Medline].

  28. Marusch F, Gastinger I. [Life-threatening complication of the Nuss-procedure for funnel chest. A case report]. Zentralbl Chir. Nov 2003;128(11):981-4. [Medline].

  29. Ohno K, Morotomi Y, Nakahira M, et al. Indications for surgical repair of funnel chest based on indices of chest wall deformity and psychological state. Surg Today. 2003;33(9):662-5. [Medline].

  30. Ravitch MM. Pectus excavatum. In: Congenital Deformities of the Chest Wall and Their Operative Correction. Philadelphia, Pa: WB Saunders Co; 1977.

  31. Robicsek F. Surgical treatment of pectus excavatum. Chest Surg Clin N Am. May 2000;10(2):277-96. [Medline].

  32. Shamberger RC. Congenital chest wall deformities. Curr Probl Surg. Jun 1996;33(6):469-542. [Medline].

  33. Stephens EH, Preventza O, Sarateanu CS, Lemaire SA, Coselli JS. Emergent pectus excavatum repair after aortic root replacement in marfan patient. J Card Surg. Mar 2012;27(2):222-4. [Medline].

  34. Tschirkov A, Baev B, Iliev R. Simultaneous pectus and open heart surgery. Chest Surg Clin N Am. May 2000;10(2):405-13, viii-ix. [Medline].

  35. Tsirikos AI, McMaster MJ. Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine. J Bone Joint Surg Am. Nov 2005;87(11):2523-36. [Medline].

 
Previous
Next
 
A 16-year-old boy with severe pectus excavatum. Note the appearance of the caved-in sternum and lower ribs.
A 10-year-old girl with severe pectus excavatum. In girls, the deformity is of particular concern because of the medial displacement of the breast, resulting in significant asymmetry of the breasts and nipples (cross-eyed appearance of the nipples).
A 10-year-old girl with severe pectus excavatum. Note the significant asymmetry of the breasts and nipples (cross-eyed appearance of the nipples).
A 12-year-old girl with severe pectus excavatum. Note the significant asymmetry of the breasts. Preoperative photograph.
A 12-year-old girl with severe pectus excavatum immediately after minimally invasive repair. Note the immediate correction of the deformity.
Preoperative photograph of a 12-year-old boy prior to minimally invasive repair of pectus excavatum.
A 12-year-old boy 2 weeks after minimally invasive repair of his pectus excavatum. Note the small lateral chest wall incision and the excellent appearance of the anterior chest with 100% correction of the pectus deformity.
Preoperative CT scan of the chest of 12-year-old girl with severe pectus excavatum (see Media file 5). Note the severe pectus excavatum with compression of the lung fields and complete displacement of the heart and mediastinal structures to the left hemi-thorax.
Illustration showing the minimally invasive technique for correction of pectus excavatum (3) with thoracoscopy (1). Note the long clamp passed from one side to the other (2) grabbing the umbilical tape (4), which serves as a guide for passage of the pectus bar behind the sternum.
Operative diagram illustrating the pectus bar after it has been passed behind the sternum (5), under thoracoscopic visualization (1), before turning it over. Note that the concavity of the bar is facing up.
Illustration of the pectus bar passed behind the sternum before and after it is turned over. The insert shows the proper technique for fixation of the pectus bar against the lateral chest wall musculature.
Illustration of the placement of the third point of fixation for stabilization of the pectus bar. Note that the nonabsorbable suture is placed around the bar and around a rib, lateral to the sternum on the anterior chest wall.
Operative diagram illustrating one of the open techniques for correction of pectus excavatum. The drawing is of the so-called "turn-over operation" for repair of pectus. It shows the extensive dissection and the radical nature of this open technique for surgical correction of this congenital chest wall deformity.
Operative photograph of the open Ravitch technique for repair of pectus excavatum. The anterior chest is exposed through an anterior thoracic incision and, after raising muscle and skin flaps, each involved cartilage is excised with preservation of the perichondrium. The picture shows one of the cartilages being removed.
Operative photograph of the completed Ravitch procedure for correction of pectus excavatum. Note the sternum fractured at 2 different points with a cartilage graft in place to maintain its new position. The involved ribs underwent perichondrial excision. The deformity is completely corrected.
Closure of the anterior chest wall incision used for the open type of repair of pectus excavatum (Ravitch operation). Note the drain (small tubing) coming out on the side of the chest. Drains are typically removed after 2-3 days, and they prevent the accumulation of fluid under the skin and muscle flaps created at the time of surgery.
Chest radiograph of a 16-year-old patient in which the bar was displaced superiorly and the 2 stabilizers were separated from the Lorenz pectus bar as a result of intense physical activity during soccer practice.
Skin rash secondary to a rare case of metal allergy caused by the pectus bar.
Recurrent pectus excavatum in a 24-year-old adult patient who underwent open repair using the Ravitch technique at age 10 years.
Chest CT scan of the recurrent pectus excavatum in the patient in Media file 20.
Recurrent pectus excavatum in young adult female patient who underwent minimally invasive repair at age 8 years.
Technique for pectus bar bending. The Lorenz bar is bent by the operating surgeon at the time of pectus bar placement using an instrument known as the "bar bender." A smooth curvature is given to the bar so that it fits under the sternum and corrects the pectus deformity.
Pectus bars of various sizes.
Technique for removal of the pectus bar. The bar and lateral stabilizer are easily exposed through the old lateral incision in the chest. Once exposed, it is pulled out using a bone-hook instrument.
Technique for removal of the pectus bar. The bar is pulled out using a bone-hook instrument.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.