Description:
Pectus excavatum is the most common congenital deformity of the sternum and anterior chest wall. It occurs in one in 1000 live births with male predominance ratio of 3:1. It is a progressive condition with the degree of chest deformity worsening with the child's growth and development.
Surgery typically takes place in mid to late childhood. The procedure involves elevating the sternum with substernally placed metal bars to correct a pectus excavatum deformity. Before insertion, the bar is gradually bent to the optimal curvature that fits the individual patient's anterior chest wall dimensions. Once inserted, the bar is then rotated so the convexity faces anteriorly. Either one or two of these bars are inserted in this manner.
The standard open Ravitch procedure involves subperichondrial resection of abnormal costal cartilages, transverse osteotomy and internal fixation of the sternum. The corrected anterior sternal position may or may not be temporarily supported with a substernal bar.
In most cases, patients with pectus excavatum are asymptomatic from a functional standpoint. However, in some cases, the cosmetic disfigurement is accompanied by restrictions in lung and/or heart development leading to a reduced cardiopulmonary function. Therefore, the primary indication for surgery is usually cosmetic but can include impaired cardiac function (typically mitral valve prolapse in 20-60% of cases), reduced pulmonary function or chest pain.
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