From the Research
For patients with concave chest, also known as pectus excavatum, the most effective treatment option is the Ravitch procedure, as it has been shown to have lower complication rates and better outcomes compared to the Nuss procedure, especially in adult patients 1.
Overview of Pectus Excavatum
Pectus excavatum is a congenital deformity where the breastbone (sternum) grows inward, creating a depression in the chest. It is the most common congenital chest wall deformity. The condition occurs due to abnormal growth of the costal cartilage connecting the ribs to the sternum, causing the sternum to be pulled inward during development.
Treatment Options
For mild cases, no treatment is necessary as it's primarily a cosmetic concern. However, for moderate to severe cases that cause breathing difficulties, chest pain, or psychological distress, treatment options include:
- The Ravitch procedure (more extensive surgery involving cartilage removal)
- The Nuss procedure (minimally invasive surgery where a curved metal bar is inserted under the sternum)
- Non-surgical approaches, such as vacuum bell therapy, which uses suction to gradually pull the sternum outward, and physical therapy exercises to improve posture and chest expansion
Comparison of Treatment Options
A systematic review and meta-analysis of comparative studies found that there was no significant difference between the Nuss and Ravitch procedures for pediatric patients, while in adults, the Ravitch procedure resulted in fewer complications 1. Another study found that the Nuss procedure can be safely and successfully used for repair of recurrent pectus excavatum after failed open surgery, but it is a more challenging procedure 2.
Long-term Results
A prospective observational study found that the Nuss procedure can be performed with excellent results in adults, both in the short term and in the long term, with improved quality of life and high patient satisfaction with cosmetic results 3. However, the Ravitch procedure is still considered the most effective treatment option, especially in adult patients.
Key Points
- Pectus excavatum is a congenital deformity that can cause breathing difficulties, chest pain, and psychological distress
- The Ravitch procedure is the most effective treatment option, especially in adult patients
- Non-surgical approaches, such as vacuum bell therapy and physical therapy exercises, can also be effective in mild cases
- Regular follow-up with a thoracic specialist is recommended for monitoring progression, especially during growth spurts in adolescence.