Pectus excavatum: how might it affect the heart?

Pectus excavatum is an anomaly of the anterior chest wall where the front chest bone (called the sternum) is sunken inside. This is a relatively common anomaly in the general population, which sometimes can appear during early childhood and become more important later on in life.

We’ve asked one of our leading paediatric cardiologists, Dr Alessandro Giardini, how the condition might affect the heart and what the treatment options are for children.

What effect does pectus excavatum have on the heart?

Pectus excavatum can have many effects on the heart. The front chest bone is moved inward and as a result the heart, which normally would sit in the centre of the chest, has to find some more space on the left side of the chest. This means that the heart tends to move sideways into the left side of the chest.

Sometimes this front chest bone can compress and push on the outside of the heart and we see that the left lung is not able to expand as it should during exercise. As a result, the flow to the lungs when people are exercising may be uneven compared to what it should be in a normal subject and therefore people can experience breathlessness.
 

Is it dangerous?

For the great majority of people affected by pectus excavatum, this will only be a cosmetic problem and in some people, it may cause symptoms like breathlessness and easy tiredness during exercise.

In a small subgroup of patients, the pectus excavatum can be associated with some anomalies of the heart. Some of which include leaky valves or an enlarged aorta, which is the main body pipe. In those children, the pectus is not necessarily dangerous on itself, but it might be a sign that there are other problems inside affecting the heart.
 

Is pectus excavatum genetic?

There is definitely an important genetic component in pectus excavatum. This defect is common in some families where several members of the family can have the same appearance of their chest. It is also sometimes present in different generations in the same families. There are some other families where no one is affected, so there is definitely a genetic component to that. This defect is more common in people that have hypermobility.
 

How do I know if my pectus excavatum is severe?

There are several criteria which are mainly based on the appearance of the pectus and based on imaging of the pectus, which is generally done with a computer tomography (CT scan) of the chest. What has to be said is that pectus excavatum sometimes can be of different degrees in different phases of life.

It's generally less common in very young children and during adolescence with a growth spurt and that's when it can become much more relevant. Severe types of pectus excavatum also tend to be more likely associated with symptoms like chest pain and breathlessness during exercise.
 

Can pectus excavatum be fixed?

Pectus excavatum can be fixed. There are different stages of pectus and different treatment options that can be offered. For mild cases especially in younger children, we can offer physiotherapy; which is able to improve the pectus significantly.

For more advanced cases we can offer some suction devices, which helps the chest to go back into the right position and for the most advanced cases we can offer surgery.

There are different types of surgery. One procedure uses a bar which pushes the chest wall back into the right position from the inside. Another option is an open procedure by which the chest wall is reconstructed in a normal way. We have a great team of surgeons that offer this type of surgery.

If you would like to discuss your child’s case of pectus excavatum with Dr Giardini, you can book an appointment to see him via his Top Doctor’s profile here.