Pectus Excavatum Surgery – Nuss Procedure


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 Children’s specialize in performing a minimally invasive procedure, known as the Nuss procedure, to repair pectus excavatum.

Frequently Asked Qustions 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.

Know the Risks of Pectus Excavatum (Sunken Chest)


Pectus excavatum, or sunken chest, is the most common congenital chest wall abnormality in children. Although some may think of the abnormality as purely a cosmetic problem, the limited chest cavity space can displace the heart as well as limit lung capacity, says Dr. Mustafa Kabeer, a pediatric surgeon at CHOC Children’s.

To schedule a consultation with a CHOC Children’s pediatric surgeon, please call 714-364-4050.

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UC Irvine

CHOC Children's is affiliated with the UC Irvine School of Medicine