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Pectus Excavatum Surgery – Nuss Procedure

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Pectus excavatum, commonly referred to as “sunken chest,” is when the breastbone, or sternum, and some of the ribs grow abnormally and cause a depression in the middle of the chest. It is the most common congenital chest wall abnormality in children.

If the depression of the chest wall is severe, it can push down on the heart and lungs and makes it hard for them to work properly. If the abnormality is severe, surgery may be recommended to correct the deformity and eliminate many symptoms such as shortness of breath, difficulty breathing during exercise, chest pain and even episodes of light-headedness. The pediatric surgeons at CHOC in Orange County, CA., specialize in performing a minimally invasive procedure, known as the Nuss procedure, to repair pectus excavatum.

Frequently Asked Questions About Pectus Excavatum

What causes pectus excavatum?

Although the cause is unknown, 40 percent of patients report a family history of pectus excavatum, and 40 percent of cases occur in tandem with scoliosis.

How common is pectus excavatum?

Pectus excavatum is one of the most common congenital chest wall abnormalities in children.

Is pectus excavatum dangerous?

Although some may think of pectus excavatum as purely a cosmetic problem, in severe cases, the limited chest cavity space can displace the heart as well as limit lung capacity. Fifteen percent of patients can experience arrhythmia (an abnormal heart rhythm) or mitral valve regurgitation, wherein the heart valves allow blood to leak backwards, as a result of the inward compression from the sternum.

How is pectus excavatum treated?

For severe cases of pectus excavatum, surgery to expand the chest wall can eliminate many symptoms. The pediatric surgeons at CHOC are experts at performing the minimally invasive Nuss procedure to repair pectus excavatum.

The Nuss procedure is a newer procedure that dramatically reduces the appearance of incisions and time spent in the operating room. A small incision is made on either side of the chest, and a small camera is inserted for observation as the surgeon passes a thin, curved metal bar through the chest cavity below the sternum. When the bar is flipped, the sunken chest is instantaneously repaired. The bar remains in place for two years, and is periodically monitored by a pediatric surgeon.

Your child will undergo a general anesthetic which will put him or her completely to sleep and prevents the sensation of pain. The full risks of anesthesia will be further explained by your child’s anesthesiologist. Learn how CHOC anesthesiologists are specifically trained in providing anesthesia for children.

Why choose the Nuss procedure?

A historical approach to these surgeries involved a large incision across the chest, and up to six hours in the operating room as the chest wall was taken apart and then reconstructed, known as the Ravitch procedure. There can also be significantly greater blood loss with the Ravitch procedure, and virtually none with the Nuss procedure.

The pectus excavatum team at CHOC is comprised of experts in pediatric pulmonology, cardiology and surgery. The multidisciplinary team performs various tests to examine heart and lung function, before and after surgery. By using the latest techniques in minimally invasive surgery, along with recent improvements in pain management, patients are able to return home and get back to their daily activities sooner than ever before.

How does the Nuss procedure work?

During the minimally invasive Nuss procedure, two small incisions are made, one on each side of the chest. A scope is used to see inside the chest. This allows us to safely guide a metal bar into the space behind the sternum while avoiding the heart and other important structures.

Through these incisions, we pass the Nuss bar, which is usually custom bent to fit the precise shape of a patient's chest. The Nuss bar rests behind the sternum, serving as a brace to reverse the sunken chest.

Once the Nuss procedure is done, the pectus excavatum is fixed. The Nuss bar will stay in place for about three years, while the bones of the chest wall remodel into the correct shape. The Nuss bar can then be removed in an outpatient surgery and the chest will not sink in again.