Pectus excavatum is the most common congenital chest wall deformity, characterized by an inward depression of the sternum (breastbone) and the rib cage. Often called “funnel chest,” this condition ranges in severity from a mild cosmetic indentation to a deep cavity that affects vital organs. Management requires a coordinated team of specialists, as no single doctor handles the condition. The specific doctors involved depend on the patient’s age, the severity of the depression, and whether treatment is non-surgical or requires a corrective operation.
The Role of Primary Care and Initial Screening
The initial identification of pectus excavatum typically begins with a primary care physician (PCP) or a pediatrician. These doctors are the first point of contact for routine check-ups and are trained to recognize physical abnormalities in children and adolescents. They assess the severity through a physical examination, noting the depth and symmetry of the sternal depression.
The PCP or pediatrician’s role is to determine if the deformity is causing any noticeable symptoms, such as shortness of breath or exercise intolerance. If the condition appears moderate or severe, or if the patient reports symptoms, the primary care provider initiates the referral process. They generally do not perform the specialized diagnostic tests but act as the coordinator to guide the patient toward the appropriate specialists for further evaluation.
Initial screening establishes a baseline for the condition’s progression, especially since the deformity can worsen during adolescent growth spurts. A key step is referring the patient for a computed tomography (CT) scan to calculate the Haller Index. This measurement divides the chest’s transverse diameter by its anterior-posterior diameter, providing an objective number for severity that guides the decision for specialist consultation or intervention.
Specialists Assessing Physiological Impact
Once identified, non-surgical specialists evaluate the physiological consequences of the depressed sternum on the heart and lungs. These assessments determine if the chest wall deformity causes functional limitations warranting surgical correction. This comprehensive evaluation ensures intervention is based on functional impairment, not solely cosmetic appearance.
Cardiologists assess potential heart compression or displacement caused by the inward sternum. They use tests like an echocardiogram to visualize the heart’s structure and function and an electrocardiogram (EKG) to check its electrical rhythm. The goal is to detect issues such as heart compression, reduced right ventricular volume, or mitral valve prolapse, which can lead to symptoms like a rapid heart rate.
Pulmonologists evaluate the patient’s breathing mechanics and lung capacity. They perform pulmonary function tests (PFTs), which measure how much air the lungs can hold and how quickly air can be moved in and out. These tests often reveal a restrictive pattern, indicating that the lungs cannot fully expand due to the compressed chest cavity. A cardiopulmonary exercise test (CPET) may also be administered to objectively measure exercise tolerance and oxygen consumption.
Physical therapists manage milder cases or support non-surgical interventions. They develop personalized regimens of static and dynamic exercises to improve posture, strengthen core and back muscles, and increase chest wall flexibility. While physical therapy cannot correct the underlying bone deformity, it helps counteract the “pectus posture” and improve breathing mechanics, sometimes serving as an adjunct to non-surgical treatments.
The Surgical Correction Team
For moderate to severe cases, or when physiological impairment is confirmed, the definitive answer to who performs the correction is a specialized surgeon. The procedure to reshape the chest wall is complex and requires expertise in thoracic anatomy.
Thoracic surgeons are the primary specialists who perform the corrective procedures for pectus excavatum. Their training focuses on the organs and structures within the chest cavity, including the lungs, heart, and chest wall. They are skilled in both the minimally invasive Nuss procedure and the open Ravitch procedure.
The Nuss procedure (Minimally Invasive Repair of Pectus Excavatum, or MIRPE) involves inserting a custom-bent metal bar under the sternum to push it outward. Pediatric surgeons often specialize in performing these procedures in younger patients. The Ravitch procedure, an open surgical approach, involves removing distorted cartilage and repositioning the sternum, typically reserved for specific anatomies or recurrent cases.
The lead surgeon works closely with a multidisciplinary surgical team to ensure a successful outcome. This team includes anesthesiologists, who manage the patient’s pain control during and after the operation, often utilizing techniques like epidurals or cryoablation. Collaboration among these professionals is essential for the technical success of the correction and the patient’s recovery.