Chest Wall Deformities

Pectus Excavatum

Description: A structural deformity where the anterior chest wall is caved-in or sunken.
Prevalence:
- Five times more common than pectus carinatum.
- Male-to-female ratio: 3-4:1.
Pathogenesis: Linked to abnormalities in costal cartilage development.
Associations:
- Mitral valve prolapse.
- Ehlers-Danlos syndrome.
- Marfan syndrome.

Haller Index: A ratio used to quantify the severity of pectus excavatum.
- Calculated using chest CT or two-view radiographs.
- A Haller index >3.2 indicates severe deformity.
Indications for Surgical Repair:
- Haller index >3.2.
- Restrictive disease on pulmonary function tests.
- Mitral valve prolapse, murmurs, or conduction abnormalities on echocardiography.
- Significant psychosocial stress related to body image or self-esteem, particularly in adolescents.

Optimal Age: 10-14 years.
Nuss Procedure (Minimally invasive):
- Performed under thoracoscopic guidance.
- Retrosternal dissection using a tunneler.
- Titanium bar is bent, passed through the retrosternal plane, and flipped to correct the chest wall defect.
- Bar is removed after approximately 2 years.
- Sternal elevation via a retractor system is used for safer dissection.
- Intercostal cryoablation and enhanced recovery pathways have reduced hospital stay to 2-3 days.

Description: Outward protrusion of the anterior chest wall.
Correction:
- Treated with a fitted chest brace.
- Requires continuous use for 14-16 hours daily for optimal results.
- Adherence to the treatment regimen is the most important predictor of success.

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