Skip to main content

Non-surgical Treatment for Pectus Excavatum and Carinatum

  • Chapter
  • First Online:
Chest Wall Deformities and Corrective Procedures

Abstract

Pectus excavatum (PE) and carinatum (PC) are characterized by an abnormal overgrowth of sternal and costal cartilages, which result in a depression or protrusion of the sternum and costal cartilages, respectively. Both chest wall malformations are cosmetic and functional pathologies. Whereas PE is commonly associated to cardiopulmonary dysfunction, PC causes deformation of the entire thoracic cage. PE is generally corrected operatively. In contrast, due to inherent risks of a major surgery, only severe cases of PC are operated. One of the authors (FMH) will describe his 12 years experience with vacuum bells to treat PE patients conservatively. The use of vacuum bells allow significant lift of the ribs and sternum, until definitive correction of cartilage growth takes place. When employed during minimally invasive repair of PE (MIRPE), vacuum bells can also be used as a tool to enhance retrosternal dissection, advancement of the pectus introducer and insertion and flipping of the pectus bar/s. The other author (MMF) will describe his 13 years experience with the FMF® Dynamic Compressor System to treat patients with PC conservatively. When considering results, there should be little doubt that no patient would be selected as a candidate for surgery before trying a non-operative approach. Further evaluation and follow-up studies are still necessary for both conservative approaches, though.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Ravitch MM. The operative treatment of pectus excavatum. Ann Surg. 1949;129(4):429–44.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Ravitch MM. The operative correction of pectus carinatum. Bull Soc Int Chir. 1975;34(2):117–20.

    CAS  PubMed  Google Scholar 

  3. Robicsek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg. 2009;21(1):64–75.

    Article  PubMed  Google Scholar 

  4. Saxena AK, Willital GH. Valuable lessons from two decades of pectus repair with the Willital-Hegemann procedure. J Thorac Cardiovasc Surg. 2007;134(4):871–6.

    Article  PubMed  Google Scholar 

  5. Wang LS, Kuo KT, Wang HW, Yang CH, Chin T. A novel surgical correction through a small transverse incision for pectus excavatum. Ann Thorac Surg. 2005;80(5):1951–4.

    Article  PubMed  Google Scholar 

  6. Fonkalsrud EW. 912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon’s experience. World J Surg. 2009;33(2):180–90.

    Article  PubMed  Google Scholar 

  7. Kelly RE, Goretsky MJ, Obermeyer R, Kuhn MA, Redlinger R, Haney TS, Moskowitz A, Nuss D. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252(6):1072–81.

    Article  PubMed  Google Scholar 

  8. Pectus UP Surgery Kit. http://venturamedicaltechnologies.com/es/productos/pectus-up. Website visited on 1 Jan 2015.

  9. Nuss D, Kelly Jr RE, Croitoru DP, et al. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg. 1998;33(4):545–52.

    Article  CAS  PubMed  Google Scholar 

  10. Kravarusic D, Dicken BJ, Dewar R, et al. The Calgary protocol for bracing of pectus carinatum: a preliminary report. J Pediatr Surg. 2006;41:923–6.

    Article  PubMed  Google Scholar 

  11. Banever GT, Konefal SH, Gettens K, et al. Nonoperative correction of pectus carinatum with orthotic bracing. J Laparoendosc Adv Surg Tech A. 2006;16:164–7.

    Article  PubMed  Google Scholar 

  12. Frey AS, Garcia VF, Brown RL, et al. Nonoperative management of pectus carinatum. J Pediatr Surg. 2006;41:40–5; discussion 40–5.

    Article  PubMed  Google Scholar 

  13. Egan JC, DuBois JJ, Morphy M, et al. Compressive orthotics in the treatment of asymmetric pectus carinatum: a preliminary report with an objective radiographic marker. J Pediatr Surg. 2000;35:1183–6.

    Article  CAS  PubMed  Google Scholar 

  14. Mielke CH, Winter RB. Pectus carinatum successfully treated with bracing. A case report. Int Orthop. 1993;17(6):350–2.

    Article  CAS  PubMed  Google Scholar 

  15. Stephenson JT, Du Bois J. Compressive orthotic bracing in the treatment of pectus carinatum: the use of radiographic markers to predict success. J Pediatr Surg. 2008;43(10):1776–80.

    Article  PubMed  Google Scholar 

  16. Lee SY, Lee SJ, Jeon CW, Lee CS, Lee KR. Effect of the compressive brace in pectus carinatum. Eur J Cardiothorac Surg. 2008;34(1):146–9.

    Article  PubMed  Google Scholar 

  17. Martinez-Ferro M, Fraire C, Bernard S. Dynamic compression system for the correction of pectus carinatum. Semin Pediatr Surg. 2008;17(3):194–200.

    Article  PubMed  Google Scholar 

  18. Martinez-Ferro M. International innovations in pediatric minimally invasive surgery: the Argentine experience. J Pediatr Surg. 2012;47(5):825–35.

    Article  PubMed  Google Scholar 

  19. Martinez-Ferro M. New approaches to pectus and other minimally invasive surgery in Argentina. J Pediatr Surg. 2010;45(1):19–26; discussion 26–7.

    Article  PubMed  Google Scholar 

  20. Schier F, Bahr M, Klobe E. The vacuum chest wall lifter: an innovative, nonsurgical addition to the management of pectus excavatum. J Pediatr Surg. 2005;40(3):496–500.

    Article  PubMed  Google Scholar 

  21. Haecker FM, Mayr J. The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction? Eur J Cardiothorac Surg. 2006;29(4):557–61. Epub 2006 Feb 13.

    Article  PubMed  Google Scholar 

  22. Haecker FM, Sesia SB. Intraoperative use of the vacuum bell for elevating the sternum during the Nuss procedure. J Laparoendosc Adv Surg Tech A. 2012;22:934–6.

    Article  PubMed  Google Scholar 

  23. Nuss D, Croitoru DP, Kelly RE, Goretsky MJ, Nuss KJ, Gustin TS. Review and discussion of the complications of minimally invasive pectus excavatum repair. Eur J Pediatr Surg. 2002;12:230–4.

    Article  CAS  PubMed  Google Scholar 

  24. Haecker F-M, Bielek J, von Schweinitz D. Minimally invasive repair of pectus excavatum (MIRPE): the Basel experience. Swiss Surg. 2003;9:289–95.

    Article  CAS  PubMed  Google Scholar 

  25. Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg. 2004;39:391–5.

    Article  PubMed  Google Scholar 

  26. Hosie S, Sitkiewicz T, Petersen C, Göbel P, Schaarschmidt K, Till H, et al. Minimally invasive repair of pectus excavatum – the Nuss procedure. A European multicentre experience. Eur J Pediatr Surg. 2002;12:235–8.

    Article  CAS  PubMed  Google Scholar 

  27. Berberich T, Haecker F-M, Kehrer B, Erb T, Günthard J, Hammer J, Jenny P. Postcardiotomy syndrome after minimally invasive repair of pectus excavatum. J Pediatr Surg. 2004;39:e1–3.

    Article  PubMed  Google Scholar 

  28. Van Renterghem KM, von Bismarck S, Bax NMA, Fleer A, Hoellwarth M. Should an infected Nuss bar be removed? J Pediatr Surg. 2005;40:670–3.

    Article  PubMed  Google Scholar 

  29. Barakat MJ, Morgan JA. Haemopericardium causing cardiac tamponade: a late complication of pectus excavatum repair. Heart. 2004;90:e22–3.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Barsness K, Bruny J, Janik JS, Partrick DA. Delayed near-fatal hemorrhage after Nuss bar displacement. J Pediatr Surg. 2005;40:E5–6.

    Article  PubMed  Google Scholar 

  31. Hoel TN, Rein KA, Svennevig JL. A life-threatening complication of the Nuss-procedure for pectus excavatum. Ann Thorac Surg. 2006;81:370–2.

    Article  PubMed  Google Scholar 

  32. Adam LA, Lawrence JL, Meehan JJ. Erosion of the Nuss bar into the internal mammary artery 4 months after minimally invasive repair of pectus excavatum. J Pediatr Surg. 2008;43:394–7.

    Article  PubMed  Google Scholar 

  33. Gips H, Zaitsev K, Hiss J. Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature. Pediatr Surg Int. 2008;24:617–20.

    Article  PubMed  Google Scholar 

  34. Haecker F-M, Berberich T, Mayr J, Gambazzi F. Near-fatal bleeding after transmyocardial ventricle lesion during removal of the pectus bar after the Nuss procedure. J Thorac Cardiovasc Surg. 2009;138(5):1240–1. Epub 2008 Sep 19.

    Article  PubMed  Google Scholar 

  35. Lange F. Thoraxdeformitäten. In: Pfaundler M, Schlossmann A, editors. Handbuch der Kinderheilkunde, Vol V. Chirurgie und Orthopädie im Kindesalter. Leipzig: FCW Vogel; 1910. p. 157.

    Google Scholar 

  36. Spitzy H. Deformitäten der Wirbelsäule. In: Lange F, editor. Lerbuch der Orthopädie. Jena: Gustav Fischer; 1922.

    Google Scholar 

  37. Bahr M. Vacuum bell procedure according to Eckart Klobe (nonsurgical). In: Schwabegger A, editor. Congenital thoracic wall deformities. Springer. 1st ed. 2011.

    Google Scholar 

  38. Haecker F-M. The vacuum bell for conservative treatment of pectus excavatum. The Basle experience. Pediatr Surg Int. 2011;27:623–7.

    Article  PubMed  Google Scholar 

  39. Haecker F-M, Zuppinger J, Sesia S. Die konservative Therapie der Trichterbrust mittels Vakuumtherapie. Schweiz Med Forum 14 2014;(45):842–9.

    Google Scholar 

  40. Mégarbané A, Daou L, Mégarbané H, et al. New autosomal recessive syndrome with short stature and facio-auriculo-thoracic malformations. Am J Med Genet A. 2004;128:414–7.

    Article  Google Scholar 

  41. Jaubert de Beaujeu M, et al. Thorax en carène. Lyon Chir. 1964;60:440–3.

    CAS  Google Scholar 

  42. Bianchi C, et al. Risultati a distanza 20 casi di “Cifosi Sternale” tratti incruentemente. Fracastoro. 1968;61:779–92.

    CAS  PubMed  Google Scholar 

  43. Welch KJ, Vos A. Surgical correction of pectus carinatum (pigeon breast). J Pediatr Surg. 1973;8:659–67.

    Article  CAS  PubMed  Google Scholar 

  44. Haller Jr JA. History of the operative management of pectus deformities. Chest Surg Clin N Am. 2000;10(2):227–35.

    PubMed  Google Scholar 

  45. Fonkalsrud EW, Beanes S. Surgical management of pectus carinatum: 30 years’ experience. World J Surg. 2001;25:898–903.

    Article  CAS  PubMed  Google Scholar 

  46. Fonkalsrud EW, Anselmo DM. Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity. J Am Coll Surg. 2004;198:898–905.

    Article  PubMed  Google Scholar 

  47. Abramson H. A minimally invasive technique to repair pectus carinatum. Preliminary report. Arch Bronconeumol. 2005;41:349–51.

    Article  CAS  PubMed  Google Scholar 

  48. Schaarschmidt K, Kolberg-Schwerdt A, Lempe M, et al. New endoscopic minimal access pectus carinatum repair using subpectoral carbon dioxide. Ann Thorac Surg. 2006;81:1099–103.

    Article  PubMed  Google Scholar 

  49. Haje SA, Bowen JR, Harcke HT, Guttenberg ME, et al. Disorders in the sternum growth and pectus deformities: an experimental model and clinical correlation. Acta Orthop Bras. 1998;6:67–75.

    Google Scholar 

  50. Haje SA, Bowen JR. Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J Pediatr Orthop. 1992;12(6):795–800.

    Article  CAS  PubMed  Google Scholar 

  51. Haje SA, Harcke HT, Bowen JR. Growth disturbance of the sternum and pectus deformities: imaging studies and clinical correlation. Pediatr Radiol. 1999;29:334–41.

    Article  CAS  PubMed  Google Scholar 

  52. Haje A, Haje DP, Silva Neto M, et al. Pectus deformities: tomographic analysis and clinical correlation. Skeletal Radiol. 2010;39(8):773–82.

    Article  PubMed  Google Scholar 

  53. Fonkalsrud EW. Pectus carinatum: the undertreated chest malformation. Asian J Surg. 2003;26:189–92.

    Article  PubMed  Google Scholar 

  54. Harrison B, Stern L, Chung P, Etemadi M, Kwiat D, Harrison M, Martinez-Ferro M. MYPECTUS: a novel mobile health system for remote assessment of treatment. Presented at the American Pediatric Surgical Association annual meeting on 31 May, 2014 in Phoenix.

    Google Scholar 

  55. Lee RT, Moorman S, Schneider M, et al. Bracing is an effective therapy for pectus carinatum: interim results. J Pediatr Surg. 2013;48(1):184–90.

    Article  PubMed  Google Scholar 

  56. Cohee AS, Lin JR, Frantz FW, Kelly Jr RE. Staged management of pectus carinatum. J Pediatr Surg. 2013;48(2):315–20.

    Article  PubMed  Google Scholar 

  57. Lopez M, Patoir A, Varlet F, Perez-Etchepare E, Tiffet T, Villard A, Tiffet O. Preliminary study of efficacy of dynamic compression system in the correction of typical pectus carinatum. Eur J Cardiothorac Surg. 2013;44(5):e316–9.

    Article  PubMed  Google Scholar 

  58. Obermeyer RJ, Goretsky MJ. Chest wall deformities in pediatric surgery. Surg Clin North Am. 2012;92(3):669–84.

    Article  PubMed  Google Scholar 

  59. Sesia S, Haecker F-M. Dynamisches Kompressionssystem bei Kielbrust - eine neuartige konservative Behandlungsmethode für Kinder und Jugendliche. Hausarzt Praxis. 2014;9(2):26–9.

    Google Scholar 

  60. de Beer SA, de Jong JR, Heij HA. Dynamische-compressiebrace bij pectus carinatum. Ned Tijdschr Geneeskd. 2013;157:159.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Frank-Martin Haecker MD, FEAPU .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Haecker, FM., Martinez-Ferro, M. (2016). Non-surgical Treatment for Pectus Excavatum and Carinatum. In: Kolvekar, S., Pilegaard, H. (eds) Chest Wall Deformities and Corrective Procedures. Springer, Cham. https://doi.org/10.1007/978-3-319-23968-2_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23968-2_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23966-8

  • Online ISBN: 978-3-319-23968-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics