Pectus excavatum and pectus carinatum: Associated conditions, family history, and post-operative patient satisfaction

Background.

Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients’ family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures.

Methods

This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution’s ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%).

Results

The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52±0.51 years and the age at the time of operation was 17.89±0.42 years; for PC patients, the corresponding ages were 15.23±0.55 years and 16.77±0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet.

In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17±0.15 for PE patients and 8.37±0.26 for PC patients. The postoperative pain duration was 51.93±5.18 days for PE patients and 38.5±6.88 days for PC patients.

Conclusion

In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.

Introduction

Pectus excavatum (PE) or ‘funnel chest’ is the most common (90%) chest wall deformity, with a 5–9:1 male predominance.^[1] It is characterized by the inward displacement of the sternum or costal cartilage. Although some families contain more than one affected person, PE is a sporadic disease.^[2] It occasionally occurs concomitantly with other anomalies, such as Marfan syndrome or scoliosis.^[2]

PE is generally asymptomatic, but in some cases, chest pain, dyspnea, diminished exercise tolerance, syncope, poor self-image, and avoidance of social interactions may occur.^[3,4] PE patients often suffer from difficulties adapting to daily social life, and aesthetic concerns negatively influence the self-esteem of patients who require a medical operation.^[5]

The deformity has a range of clinical presentations, and asymmetry is frequently noted on the right side of the chest wall, which may even result in rotation of the sternum.^[3] Moreover, scoliosis is present in 5% of PE patients, while congenital cardiac anomalies and asthma are found less frequently.^[3,4]

The classical method of correcting RE, the Ravitch procedure, includes sub-perichondrial resection and sternal turnover.^[6] The Nuss procedure, which is more commonly performed than the Ravitch procedure, is a minimally invasive technique in which a metal bar is used to elevate the depressed sternum and costal cartilage.^[6]

Pectus carinatum (PC) or ‘pigeon chest’ is the second most commonly seen chest wall deformity.^[1] PC is also sporadic and is less common than PE. It also affects males more than females, and is characterized by anterior angulation of the sternum and protrusion of the costal cartilage.^[4]

Children with PC may be less self-confident and more self-conscious.^[7] These problems result in an abnormal posture, which exacerbates PC.^[7] A minimally invasive method of surgical correction, known as the Abramson procedure, was developed on the basis of the Nuss procedure. The Abramson procedure involves a presternally placed metal bar that compresses the sternum and is attached to both sides of the chest wall.^[8]

Minimally invasive repair of PE ^[9] and PC ^[10] (the Nuss and Abramson procedures) is the currently preferred treatment. In the present study, we aimed to characterize how patients obtained information regarding their condition, their family history, associated medical problems, and postoperative satisfaction and pain levels after the Nuss and Abramson procedures.

References

Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction, Pinar Kuru MD, Aylin Cakiroglu MI, Aynur Er MS, Hincal Ozbakir MI, Ali Emin Cinel MS, Busra Cangut MS, Merve Iris MS, Berkay Canbaz MS, Ebru Pıçak MS, and Mustafa Yuksel MD. Korean J Thorac Cardiovasc Surg. 2016 Feb; 49(1): 29–34.