Pectus excavatum is a congenital chest wall deformity characterized by a sunken or caved-in appearance of the breastbone. This condition, sometimes called “funnel chest,” can range in severity from a mild, barely noticeable indentation to a deep depression that visibly affects the chest contour. While a common concern for individuals and their families is the potential for serious health consequences, death directly from pectus excavatum is exceedingly rare. However, in severe instances, the deformity can indeed lead to significant physiological challenges affecting the heart and lungs.
Understanding Pectus Excavatum
Pectus excavatum is the most common congenital abnormality of the chest wall, affecting approximately 1 to 8 people per 1,000 births and occurring more frequently in males. Though present at birth, the indentation often becomes more noticeable and can worsen during periods of rapid growth, such as adolescence. This inward growth of the sternum results from abnormal development of the cartilage connecting the ribs to the breastbone.
The physical appearance of pectus excavatum varies widely. While many individuals with a mild form experience no symptoms, the degree of the indentation can determine its physiological effects on internal organs.
How Pectus Excavatum Affects Heart and Lungs
The depressed sternum in pectus excavatum can reduce the space available within the chest cavity, potentially affecting the heart and lungs. The severity of this impact directly correlates with the depth of the chest wall indentation. When the breastbone sinks inward, it can physically displace or compress the heart, which normally sits behind and slightly to the left of the sternum.
This compression can lead to various cardiac manifestations. The heart may be pushed to the left side of the chest, and in some cases, its ability to fill with blood and pump efficiently can be reduced, particularly during strenuous activity. Individuals might experience symptoms such as a fast heart rate, palpitations, or heart murmurs due to the sternum’s proximity to the pulmonary artery.
Furthermore, the restricted chest volume can limit the lungs’ capacity to fully expand. This pulmonary restriction can lead to symptoms like shortness of breath, especially during exercise, and decreased endurance. Some individuals may also experience fatigue or a reduced ability to engage in prolonged physical activity. While simple lung function tests might appear normal in many cases, more sophisticated assessments during exercise can reveal reduced pulmonary reserve and breathlessness.
When Pectus Excavatum Becomes Serious
While pectus excavatum rarely leads to direct fatality, its severity can progress to a point where it significantly compromises heart and lung function. Serious complications typically arise in cases with a deep indentation, where the chest wall exerts substantial pressure on internal organs. Clinicians often assess severity based on the depth of the sternal depression, sometimes using imaging studies.
In such severe instances, continuous compression can lead to significant cardiac compromise. This might manifest as a marked reduction in the heart’s pumping efficiency, leading to symptoms consistent with heart failure, such as chronic fatigue and severe exercise intolerance. Similarly, profound respiratory issues can develop, where the lungs are so restricted that adequate breathing becomes difficult, especially during exertion or illness, limiting oxygen intake and overall stamina.
These extreme outcomes are highly uncommon. Death directly attributable to pectus excavatum is exceedingly rare, and severe complications typically occur only in profoundly severe, untreated cases, or in conjunction with other underlying health conditions. The primary concern for most individuals with severe pectus excavatum is a reduced quality of life due to physical limitations rather than life-threatening events.
Treating Severe Pectus Excavatum
For individuals experiencing significant symptoms or severe compression from pectus excavatum, surgical correction is often considered. The primary goal of these procedures is to alleviate pressure on the heart and lungs, improve their function, and restore a more typical chest contour. Surgical intervention is typically recommended for symptomatic moderate to severe cases.
Two main surgical approaches are commonly used. The Nuss procedure is a minimally invasive technique where a curved metal bar is inserted behind the breastbone through small incisions on the sides of the chest. This bar is then rotated to push the sternum outward into a corrected position and is typically left in place for two to three years before removal. The Ravitch procedure, an older and more open technique, involves removing deformed cartilage and repositioning the sternum, sometimes with the aid of a support bar or plate. Both procedures aim to create more space for the thoracic organs.
While surgery is the main intervention for severe cases, milder forms or those seeking symptom relief may consider non-surgical management options like physical therapy or vacuum bell therapy. Post-treatment outcomes are generally positive, with many patients reporting significant improvement in symptoms such as shortness of breath, chest pain, and exercise tolerance. Surgical correction enhances physical well-being and can prevent progression to more critical states.