November 17, 2022 Author : José Roquette Pectus excavatum is the most common morphological deformity of the chest wall: it represents about 90% of cases. The first description of pectus excavatum dates back to the 15 th century. It is characterized by depression of the sternum, which causes a 'pit' to form in the middle of the chest ; The sternum is a flat bone located in the anterior midline of the rib cage, to which the first 10 ribs are attached through the costal cartilages. Pectus excavatum surrounds the sternum and costal cartilages. The exaggerated growth of the costal cartilages displaces the sternum, pushing it inwards and giving rise to a depression; The deformity may be symmetrical, or the right and left sides may be different. What is the cause and in whom does it happen? The exact cause of pectus excavatum is not known, but it appears to be associated with changes related to cartilage development . It may occur isolated or be associated with other diseases, some of which are genetic; Although there may be some hereditary relation, having pectus excavatum does not mean that descendants will have it too; The deformity is in most cases congenital , ie it is present at birth. Its evolution is variable. In some less pronounced cases it can disappear with growth. However, it rarely improves after the age of 6 and, even when it is mild, it can be accentuated with the rapid growth in puberty and adolescence; It is three times more common in boys and occurs in about 1 in 300-1000 newborns. Consequences of pectus excavatum Pectus excavatum can affect quality of life, physical and mental health. A physical deformity, especially when it is accentuated, can imply difficulty in social relationships . Attempting to hide it, by arching the shoulders and bending the head forward, can contribute to posture problems in the medium to long term . Depending on its severity , pectus excavatum can be associated with exercise intolerance, chest pain, difficulty breathing, or a lack of physical stamina. In extreme cases, it can compromise heart function. Treatment of pectus excavatum There are several non-surgical and surgical approaches to pectus excavatum treatment. If the pectus excavatum is minor, physical therapy with exercises to strengthen the thoracic muscles or the use of orthoses are among the non-surgical interventions with which good results are obtained. The indication for surgery is related to the severity and evolution of the deformity, its psychological impact and symptoms. In mild cases, when in general there are no cardiorespiratory symptoms, the psychological impact and aesthetic concerns are the main reasons for surgery indication; When pectus excavatum causes cardiorespiratory symptoms, these may justify surgical indication, always depending on the individual particulars. Whenever there is an indication for surgery, the ideal phase to perform it is between about 8 years of age and the end of adolescence . Surgery can be performed using different techniques, both open (with a large incision) and minimally invasive (through small holes), it is performed by doctors specializing in thoracic surgery and always involves the placement of a metal prosthesis behind the sternum to allow correction, and which should be maintained for about 2 months. Its removal is simple. Meet the thoracic surgery clinical team from Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
