The Chest Wall program at Shriners Hospitals for
Children – Northern California provides children the
most advanced pediatric medical care. The expert pediatric
surgery team coordinates care for several kinds of chest wall
irregularities.
The most common chest wall abnormality seen in children is Pectus
Excavatum (PE), translated literally as “hollowed chest” and also
referred to as “sunken chest” or “funnel chest.” This is a
condition in which a person’s breastbone is sunken into their
chest, causing the chest to look hollow or dented.
If severe, it can compress or displace the heart and lungs
causing shortness of breath, chest pain, palpitations and
respiratory disease. Some patients also suffer
psychologically and emotionally as a result of the
disorder. Negative body image, low self-esteem, and social
awkwardness. This is especially true for teenagers as the
pectus defect often worsens during the adolescent years, a time
when the child may be seeking peer acceptance.
Fortunately, our internationally noted pediatric surgeons can
correct chest wall issues with minimally invasive surgery. Above
all, our medical team works together to ensure that children
benefit from the most advanced pediatric medical care.
Medical Concentration
- Pectus Excavatum (Sunken Chest)
- Pectus Carinatum (Raised Chest)
- Poland’s Syndrome
Patient Evaluation
Chest wall malformations are not readily apparent in all
patients. Symptoms vary with the severity of the abnormality, and
younger children are less symptomatic than older children. Mild
breathing problems and chest pain in the area of the rib
cartilages require medical evaluation. To find out more
information about how to make an appointment, please visit
this page.
What is the Cause of Pectus Excavatum?
The cause of pectus excavatum is not known however it occurs in
approximately 1 out of 300–400 children and is three to five
times more common in males than females. This may be an isolated
abnormality or may be found with other malformations including
scoliosis, kyphosis, and connective tissue disorders such as
Marfan syndrome. The deformity usually becomes more severe as the
child grows.
What are Some Symptoms Associated with Pectus Excavatum?
- Chest or rib pain
- Limited stamina with exercise
- Shortness of breath and respiratory disease
- Palpitations
- Some patients also suffer psychologically and emotionally as
a result of the disorder.
- Negative body image, low self-esteem, and social awkwardness.
How are Pectus Conditions Typically Treated?
Pectus treatments range from simple observation to bracing and in
some cases, surgery. Talk openly and honestly with your child
about the condition to determine how this is affecting their
health and well-being. The psychological impact can be
significant to some children. At Shriners Hospitals for Children
– Northern California, pediatric surgery is delivered in a
hospital designed specifically to serve the medical and emotional
needs of children and their families. Our internationally noted
pediatric surgeons can correct chest wall abnormalities with
minimally invasive surgery.
What are the Different Types of Surgical Repair for Pectus
Deformities?
- Patients with Pectus Excavatum typically undergo the Nuss
Procedure (bottom section move up to top). Nuss Procedure, which
is known to be the minimally invasive repair with a metal pectus
bar, is achieved by bending a bar to fit the chest wall. The bar
is then inserted and secured through a small incision under each
arm using the aid of an endoscope to monitor and avoid injury to
the heart during insertion. The bar goes over the ribs and under
the sternum, to push the sternum forward into the new position.
The ends of the bar are secured to the chest wall. The bar is
kept in place for 2-3 years and then removed. This Nuss procedure
takes 2-4 hours and removal takes 1-2 hours. Patients who undergo
a Nuss Procedure typically stay in the hospital for 1-3 days.
Nuss bar removals are an outpatient procedure, with discharge
occurring the same day as the operation.
- Patients with Pectus Carinatum may choose to undergo a
Ravitch Procedure. Ravitch Procedure is done through an up and
down incision across the mid chest. In this repair, the abnormal
costal cartilages are removed. This procedure takes approximately
4–6 hours. In certain patients, an osteotomy (a break) in the
sternum is done to allow the sternum to be positioned more
typically. Sometimes, a temporary metal chest strut (bar) may
need to be placed during the operation. Patients who have a
Ravitch procedure typically stay in the hospital for 1-3 days.
Meet the Team
Four pediatric surgeons and a pediatric nurse practitioner work
together to deliver complex, compassionate care.
Diana Farmer,
M.D.
Pediatric Surgeon in Chief
Shinjiro (Shin)
Hirose, M.D.
Director, Pediatric Surgery
Gary Raff,
M.D.
Pediatric Cardiothoracic Surgeon
Amy Rahm,
M.D.,
Pediatric Cardiothoracic Surgeon
Jennifer Miranda
Nurse Practitioner
Kat Swartz
Nurse Practitioner
