Pectus excavatum: how might it affect the heart?

Written by: Dr Alessandro Giardini
Edited by: Laura Burgess

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.

By Dr Alessandro Giardini
Paediatric cardiology

Dr Alessandro Giardini is an award-winning and leading cardiologist based at the world-renowned Great Ormond Street Hospital (GOSH) in London, specialising in paediatric cardiology. An expert on congenital heart disease, Dr Giardini is the lead of inpatient services at GOSH, and also provides outpatient consultations for all manner of heart problems in children, including palpitations, heart murmurs, chest pain, and heart valve issues. He also privately practices at The Harley Street Clinic Children's Hospital, The Portland Hospital and Chase Lodge Hospital, alongside Bupa Cromwell Hospital.

Dr Giardini's experience in congenital heart disease extends to the diagnosis and management of a wide range of defects in babies, children and adolescents. His GOSH unit has pioneered techniques including transcatheter pulmonary valve replacement and Dr Giardini's involvement in paediatric cardiac research means his patients are treated according to the latest and most successful techniques.

Dr Giardini, who is a Top Doctors 2021 award winner, also leads specialist clinics for children with paediatric hypertrophic cardiomyopathy. He's highly regarded for expertise in providing guidance for children and adolescents with documented cardiac disease and those with symptoms during exercise, such as palpitations, chest pains or fainting/syncope.  

His philosophy is a patient-centric approach, delivering treatment with compassion and understanding, and personalising his consultations and treatment to each child and their family.    ​

Dr Giardini has a medical degree and a PhD (in the pathology of heart failure in patients with congenital heart defects) from the University of Bologna's (Italy) School of Medicine. Dr Giardini went on to undergo extensive training in paediatric cardiology both in Bologna and in San Francisco, USA. He is actively involved in research, having published over 120 articles in peer-reviewed journals.  

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