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Common 'Funnel Chest' Deformity Could Be Repaired More Often
March 17, 2000 (Washington) -- Parents of babies born with a sunken breast bone, a condition called funnel chest, are often told that the deformity will improve with age and shouldn't cause the child any heart or lung problems. But that advice is frequently wrong, and many children who could benefit from corrective surgery -- and who do better when they have the procedure before adolescence -- are being denied treatment, according to some surgeons.
Successful surgical repair for funnel chest, technically termed pectus excavatum, has been practiced for more than 50 years, and a new technique was developed about 10 years ago. A study in the March issue of the journal Annals of Surgery shows that nearly 400 patients who had the surgery at UCLA Medical Center did extremely well. The lead author of the study, who performed most of the surgeries himself, tells WebMD he hopes it will spur more surgeons and pediatricians to recommend this procedure to appropriate patients.
"We hope that publishing a report with a large number of patients with excellent results, no major complications, and an average hospital stay of three days, will cause this to be considered more frequently for repair," says Eric Fonkalsrud, MD, a professor of surgery at the UCLA School of Medicine.
Estimates vary, but pectus excavatum, or funnel chest, is thought to occur in one of every 600 to 2,000 newborns. It is caused by an overgrowth of cartilage between the sternum and the ribs, which causes the bone to turn inward. Only 15% undergo surgery to repair the sunken grooves and concave appearance that mark their bodies, usually for life. Many children will start to experience symptoms around school age, and often they complain of shortness of breath and reduced endurance. Many are extremely self-conscious about their appearance, don't participate in sports, and will not wear bathing suits; boys often refuse to go shirtless. The disorder is twice as common in men than women and can run in families.
Of the patients who underwent surgical repair for pectus excavatum at UCLA from January 1969 through November 1999, 97% had very good or excellent results. They ranged in age from 2 to 53; nearly 80% were males. Prior to surgery, almost all patients had some displacement of the heart to the left side and reported mild to severe decreased stamina and exercise endurance.
Fonkalsrud and his colleagues performed the repair using a technique developed more than 50 years ago. The procedure, performed under general anesthesia, takes about three hours and involves removing cartilage overgrowth from affected ribs at the connection point to the sternum, with a steel rod or strut placed across the chest to support the top of the sternum and then wired to surrounding ribs. The inpatient stay for the procedure averaged just over three days.
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