Pectus excavatum: More than a matter of aesthetics

Pectus excavatum (PE) is the most common congenital chest abnormality, and affects males 5 times more frequently than females. PE results from improper fusion of the ribs with the sternum during embryologic development. The cardinal presenting sign is chest depression. Evaluation includes serial measurement of the chest deformity defect. Additional evaluation of cardiopulmonary function, including arrhythmias and pulmonary function tests, should be done as well. Computed tomography scans are used to determine the Haller index, a measure of deformity severity, with a measurement of greater than 3.2 deemed severe. The main indication of repair is decreased cardiopulmonary capacity, not cosmetic. Surgical repair should be timed such that it occurs after the pediatric growth spurt. Generally, the Nuss procedure, which is minimally invasive, is the first-line surgical repair. Ravitch, or open repair, is used for more complex or asymmetric deformities.