Materiały źródłowe

• #1 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #2 Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification – Janssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/82552/html

  Pectus excavatum accounts for approximately 6595% of all chest wall deformities depending on the population being studied. Males are reported to be affected three to five times more often than females. No direct racial predisposition has been observed, although the deformity is more frequently described in Caucasians than among African Americans, Hispanics, or Asians. […] In literature, incidence rates of up to 8 per 1,000 live births have been reported. However, the true incidence and prevalence of pectus excavatum are not well-established yet and may be much higher than the currently described rates (up to 5% based on radiologic reports), as no large-scale, population-based studies have been conducted. Due to the absence of a clear definition of pectus excavatum and the key factor in diagnosing being visual examination, a well-founded estimation of the prevalence of the deformity is challenging. The dynamic nature of the deformity, which in most patients becomes more prominent and noticeable during early childhood and adolescence, further complicates determination of the number of cases in a population. Furthermore, there is still limited awareness of the deformity among the general population as well as healthcare providers, which may add to underreporting or misdiagnosing the deformity. […] While the global interest in pectus excavatum is currently higher than in pectus carinatum, which might reflect the real-world prevalence, the global trend in internet searches related to the topic pectus excavatum is decreasing each year.

• #3 Outcome of surgical repair of Pectus Excavatum in adults | Journal of Cardiothoracic Surgery | Full Text

  https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-017-0635-z

  Pectus Excavatum (PEx) is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities, with an incidence rate of approximately 0.1%, and a male to female ratio of 4:1. […] Surgical correction is recommended because severe PEx can affect the physical and psychological development of patients. […] Routine early repair of Pectus Excavatum in patients older than 3 years of age is safe and effective as the chest wall is more malleable. […] There were limited studies regarding open surgical repair in adults, because of that our aim was to assess the impact of surgical repair of Pectus Excavatum in adults during hospital course and results after 1 year. […] The degree of internal compression is variable and can be graded by HI (Haller Index). HI (maximal transverse diameter/narrowest AP length of chest) is used to assess severity of incursion of the sternum into the mediastinum.

• #4 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #5 Pectus excavatum | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pectus-excavatum?lang=us

  It accounts for 90% of chest wall deformities, occurring in up to 1 in 300-1000 births, more frequently seen in males (M:F = 3:1). […] Although most are sporadic it can be seen in association with: Marfan syndrome, Noonan syndrome, Ehlers-Danlos syndrome, neurofibromatosis type I, myotonic dystrophy, fetal alcohol syndrome, homocystinuria, osteogenesis imperfecta, congenital scoliosis, Poland syndrome, arterial tortuosity syndrome.

• #6 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #7 Pectus Excavatum | Sunken Chest Surgery | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/pectus-excavatum/

  Pectus excavatum, also known as sunken chest or funnel chest, is the most frequent congenital anomaly of the chest wall, occurring in 1 in 400 births, and is found in 2.6 percent of children aged 714. […] Sunken chest seems to be more common in boys than girls. […] The cause is not known, but there is sometimes a tendency to run in families.

• #8 Pectus Excavatum – MU Health Care

  https://www.muhealth.org/conditions-treatments/pediatrics/general-surgery/chest-wall-deformities/pectus-excavatum

  Pectus excavatum also known as sunken chest or funnel chest occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved-in or sunken appearance. It is the most common chest wall deformity, occurring in 1 in 400 births and found in 2.6% of 7- to 14-year-old children. […] Most kids begin showing symptoms of pectus excavatum during adolescence as their bones grow rapidly. […] Though it is typically a standalone condition, up to 20% of patients might have additional skeletal conditions, such as scoliosis.

• #9 Pectus Excavatum | University of Utah Health

  https://healthcare.utah.edu/pediatric-surgery/conditions/chest-wall-deformities/pectus-excavatum

  Pectus excavatum affects about 1 in 400 children. Its three times more common in boys than in girls. […] University of Utah specialists with the Utah Pectus Program treat more than 100 children with pectus excavatum each year.

• #10 Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232575

  When we apply these same thresholds to the DHS1 cohort, we find that 0.5% have a Haller index 3.25 and 5% have a Correction index 10%. […] A higher prevalence is found in women (0.5%; 1 in 200) than men (0.3%; 1 in 333). […] In this study we estimate the prevalence of pectus excavatum at ~0.4%, or 1 in 250 individuals, in a large, population-based, multiethnic, adult population with a median age of 44 years.

• #11 Prevalence of Pectus Excavatum in an Adult Population-Based Cohort Estimated from Radiographic Indices of Chest Wall Shape

  https://unthsc-ir.tdl.org/items/95daa055-839d-4033-a8e9-bf8f0645db40

  Pectus excavatum is the most common chest wall skeletal deformity. […] Although commonly evaluated in adolescence, its prevalence in adults is unknown. […] At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller Index 3.25, Correction Index 10%, or both, respectively. […] There is a greater prevalence of pectus in women than men. […] In this study, we estimate the prevalence of pectus excavatum at 0.4% or 1 in 25 individuals in a large, population-based, multi-ethnic adult population with a mean age of 44 years old. […] To our knowledge, this is the first population-based study estimating the prevalence of pectus in adults.

• #12 Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification – Janssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/82552/html

  Pectus excavatum accounts for approximately 6595% of all chest wall deformities depending on the population being studied. Males are reported to be affected three to five times more often than females. No direct racial predisposition has been observed, although the deformity is more frequently described in Caucasians than among African Americans, Hispanics, or Asians. […] In literature, incidence rates of up to 8 per 1,000 live births have been reported. However, the true incidence and prevalence of pectus excavatum are not well-established yet and may be much higher than the currently described rates (up to 5% based on radiologic reports), as no large-scale, population-based studies have been conducted. Due to the absence of a clear definition of pectus excavatum and the key factor in diagnosing being visual examination, a well-founded estimation of the prevalence of the deformity is challenging. The dynamic nature of the deformity, which in most patients becomes more prominent and noticeable during early childhood and adolescence, further complicates determination of the number of cases in a population. Furthermore, there is still limited awareness of the deformity among the general population as well as healthcare providers, which may add to underreporting or misdiagnosing the deformity. […] While the global interest in pectus excavatum is currently higher than in pectus carinatum, which might reflect the real-world prevalence, the global trend in internet searches related to the topic pectus excavatum is decreasing each year.

• #13 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #14 Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification – Janssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/82552/html

  Pectus excavatum accounts for approximately 6595% of all chest wall deformities depending on the population being studied. Males are reported to be affected three to five times more often than females. No direct racial predisposition has been observed, although the deformity is more frequently described in Caucasians than among African Americans, Hispanics, or Asians. […] In literature, incidence rates of up to 8 per 1,000 live births have been reported. However, the true incidence and prevalence of pectus excavatum are not well-established yet and may be much higher than the currently described rates (up to 5% based on radiologic reports), as no large-scale, population-based studies have been conducted. Due to the absence of a clear definition of pectus excavatum and the key factor in diagnosing being visual examination, a well-founded estimation of the prevalence of the deformity is challenging. The dynamic nature of the deformity, which in most patients becomes more prominent and noticeable during early childhood and adolescence, further complicates determination of the number of cases in a population. Furthermore, there is still limited awareness of the deformity among the general population as well as healthcare providers, which may add to underreporting or misdiagnosing the deformity. […] While the global interest in pectus excavatum is currently higher than in pectus carinatum, which might reflect the real-world prevalence, the global trend in internet searches related to the topic pectus excavatum is decreasing each year.

• #15 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #16 Pectus excavatum from a pediatric surgeon’s perspective – Nuss- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/11847/12234

  Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. […] The overall incidence of familial pectus excavatum in our series is 40%. Genetic studies have been ongoing without identification of a specific gene but there is strong evidence of autosomal recessive genetic control. […] The male to female ratio has remained 4:1 in favor of boys throughout the last century. […] Although the incidence of congenital pectus excavatum can be debated, the more important question is at what age should one offer surgical repair in a patient with a severe pectus excavatum. […] At CHKD, we typically follow uncorrected patients yearly, but soon after the 10th birthday we begin to review them more frequently to help optimize the timing of surgery. […] Close observation during this time period allows the patient and family to be presented with various treatment strategies.

• #17 Pectus Excavatum | Children’s Mercy Kansas City

  https://www.childrensmercy.org/departments-and-clinics/center-for-pectus-excavatum-and-carinatum/pectus-excavatum/

  Pectus excavatum occurs in about 1 in 1,000 children and boys are 4 times more likely to have this condition than girls. […] While we don’t know the exact causes of pectus excavatum, the condition tends to run in families. About 25 percent of children with this condition discover a family history of others with funnel chest (also known as caved-in chest).

• #18 Heart Disease and Pectus Excavatum: An Underestimated Issue—Single Center Experience and Literature Review

  https://www.mdpi.com/2075-1729/14/12/1643

  Pectus excavatum (PE) is the most common chest wall congenital deformity. The incidence is around 1 in 400 children, and it occurs four times more frequently in males than in females. […] Generally, it is an isolated congenital abnormality, but, rarely, concurrent congenital heart disease may be found in these patients. […] PE is common in patients with connective tissue disorders; in particular it has been observed in two-thirds of patients with Marfan syndrome (MS), an autosomal dominant disease that particularly affects the cardiovascular system. […] The aim of this study is to describe our experience of concurrent PE and cardiac disease, emphasizing the importance of surgical correction in symptomatic patients with a severe chest wall depression, causing cardiopulmonary complications secondary to the mechanical compression of the heart.

• #19 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #20 Outcomes in adult pectus excavatum patients undergoing Nuss repair | PROM

  https://www.dovepress.com/outcomes-in-adult-pectus-excavatum-patients-undergoing-nuss-repair-peer-reviewed-fulltext-article-PROM

  Pectus excavatum (PEx) is one of the most common congenital chest wall deformities. […] The deformity is reported to occur more frequently in males than females; however, diagnosis in females may often be missed if obscured with breast tissue. […] The cardiopulmonary effects of PEx have been debated for years, and there is a paucity of reports evaluating adult patients. […] The inward deformity of the anterior chest wall has a negative cardiopulmonary consequence on patients with PEx, as supported by the most recent data. […] Long-term follow-up of corrected PEx patients and correlations between physiologic impact and symptoms are lacking. […] There has been a greater recognition of the physiologic and psychologic impact of these patients. […] The importance of corrective surgery for improvement in psychological distress, quality of life, and exercise tolerance has been documented in the literature.

• #21 Pectus Excavatum: Old Problem, Brief History, New Evidence

  https://oregonpediatricsociety.org/pectus-excavatum-old-problem-brief-history-new-evidence/

  As many as 1 in 400 people have pectus excavatum, a depression deformity of the chest. […] Commonly, those affected have not been offered work up or treatment; female patients are especially under diagnosed, as their breast tissue can make it difficult to assess the severity of the deformity. […] Surgical treatment is the gold standard for severe pectus excavatum. […] The Nuss procedure is now internationally accepted as the standard of care for correction of severe pectus excavatum. […] A Haller Index of 3.25 or higher defines a severe case of pectus excavatum. […] Patients with severe pectus excavatum are candidates for the Nuss procedure or MIRPE. […] In summary, there is a safe and effective treatment for teens and adults with pectus excavatum.

• #22 Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232575

  When we apply these same thresholds to the DHS1 cohort, we find that 0.5% have a Haller index 3.25 and 5% have a Correction index 10%. […] A higher prevalence is found in women (0.5%; 1 in 200) than men (0.3%; 1 in 333). […] In this study we estimate the prevalence of pectus excavatum at ~0.4%, or 1 in 250 individuals, in a large, population-based, multiethnic, adult population with a median age of 44 years.

• #23 Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification – Janssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/82552/html

  Pectus excavatum accounts for approximately 6595% of all chest wall deformities depending on the population being studied. Males are reported to be affected three to five times more often than females. No direct racial predisposition has been observed, although the deformity is more frequently described in Caucasians than among African Americans, Hispanics, or Asians. […] In literature, incidence rates of up to 8 per 1,000 live births have been reported. However, the true incidence and prevalence of pectus excavatum are not well-established yet and may be much higher than the currently described rates (up to 5% based on radiologic reports), as no large-scale, population-based studies have been conducted. Due to the absence of a clear definition of pectus excavatum and the key factor in diagnosing being visual examination, a well-founded estimation of the prevalence of the deformity is challenging. The dynamic nature of the deformity, which in most patients becomes more prominent and noticeable during early childhood and adolescence, further complicates determination of the number of cases in a population. Furthermore, there is still limited awareness of the deformity among the general population as well as healthcare providers, which may add to underreporting or misdiagnosing the deformity. […] While the global interest in pectus excavatum is currently higher than in pectus carinatum, which might reflect the real-world prevalence, the global trend in internet searches related to the topic pectus excavatum is decreasing each year.

• #24 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #25 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #26 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Pectus excavatum occurs in an estimated 1 in 300-400 births, with male predominance (male-to-female ratio of 3:1). Pectus excavatum comprises approximately 90% of all chest wall deformities. […] Although limited data are available, international frequency is probably the same as that reported in the United States. However, in certain countries (eg, Argentina), pectus carinatum is more common than pectus excavatum. […] Pectus excavatum appears to be most prevalent in whites. Unfortunately, no specific data are available regarding racial distribution; however, clinical observation indicates that treating pectus excavatum in African Americans is unusual. […] The male-to-female ratio is 3:1. Despite such observation, no known genetic factor linked to the X or Y chromosome has been reported.

• #27 The Epidemiology behind Pectus Excavatum: Clinical Study and Review of the Literature – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34126636/

  Pectus excavatum (PE) is a funnel-shaped indentation of the sternum and is the most common deformity of the chest wall. […] Familial occurrence is assumed in up to 40% of cases, but large-scale studies are lacking. […] This study was designed to provide basic information on the epidemiology, family history, and comorbidity for a large cohort of isolated PE and to show that there is an inheritance pattern for PE that indicates a genetic background. […] Family history was available for 78 patients. A positive family history was found in 42 patients (54%) with a total of 53 affected family members. […] The described family histories indicate an underlying genetic cause for PE. Identification of the genetic factors may contribute to characterize patients who are at risk of inheriting isolated PE.

• #28 Pectus excavatum – Wikipedia

  https://en.wikipedia.org/wiki/Pectus_excavatum

  Pectus excavatum occurs in an estimated 1 in 150 to 1 in 1000 births, with male predominance (male-to-female ratio of 3:1). In 35% to 45% of cases family members are affected.

• #29 Pectus excavatum from a pediatric surgeon’s perspective – Nuss- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/11847/12234

  Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. […] The overall incidence of familial pectus excavatum in our series is 40%. Genetic studies have been ongoing without identification of a specific gene but there is strong evidence of autosomal recessive genetic control. […] The male to female ratio has remained 4:1 in favor of boys throughout the last century. […] Although the incidence of congenital pectus excavatum can be debated, the more important question is at what age should one offer surgical repair in a patient with a severe pectus excavatum. […] At CHKD, we typically follow uncorrected patients yearly, but soon after the 10th birthday we begin to review them more frequently to help optimize the timing of surgery. […] Close observation during this time period allows the patient and family to be presented with various treatment strategies.

• #30 Pectus Excavatum | MUSC Health | Charleston SC

  https://musckids.org/our-services/surgery/chest-wall-deformity-center/pectus-excavatum

  Pectus excavatum occurs in 1 in 350 births with a male to female predominance of 3:1. […] Despite the lack of an identified genetic marker, there is a familial occurrence in at least 35% of cases. […] Several studies have shown changes in pulmonary function, primarily related to pulmonary reserve and ventilation volume. […] Other studies have suggested alterations in cardiac function, particularly with exercise.

• #31 The Epidemiology behind Pectus Excavatum: Clinical Study and Review of the Literature – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34126636/

  Pectus excavatum (PE) is a funnel-shaped indentation of the sternum and is the most common deformity of the chest wall. […] Familial occurrence is assumed in up to 40% of cases, but large-scale studies are lacking. […] This study was designed to provide basic information on the epidemiology, family history, and comorbidity for a large cohort of isolated PE and to show that there is an inheritance pattern for PE that indicates a genetic background. […] Family history was available for 78 patients. A positive family history was found in 42 patients (54%) with a total of 53 affected family members. […] The described family histories indicate an underlying genetic cause for PE. Identification of the genetic factors may contribute to characterize patients who are at risk of inheriting isolated PE.

• #32 The Epidemiology behind Pectus Excavatum: Clinical Study and Review of the Literature – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34126636/

  Pectus excavatum (PE) is a funnel-shaped indentation of the sternum and is the most common deformity of the chest wall. […] Familial occurrence is assumed in up to 40% of cases, but large-scale studies are lacking. […] This study was designed to provide basic information on the epidemiology, family history, and comorbidity for a large cohort of isolated PE and to show that there is an inheritance pattern for PE that indicates a genetic background. […] Family history was available for 78 patients. A positive family history was found in 42 patients (54%) with a total of 53 affected family members. […] The described family histories indicate an underlying genetic cause for PE. Identification of the genetic factors may contribute to characterize patients who are at risk of inheriting isolated PE.

• #33 Pectus excavatum from a pediatric surgeon’s perspective – Nuss- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/11847/12234

  Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. […] The overall incidence of familial pectus excavatum in our series is 40%. Genetic studies have been ongoing without identification of a specific gene but there is strong evidence of autosomal recessive genetic control. […] The male to female ratio has remained 4:1 in favor of boys throughout the last century. […] Although the incidence of congenital pectus excavatum can be debated, the more important question is at what age should one offer surgical repair in a patient with a severe pectus excavatum. […] At CHKD, we typically follow uncorrected patients yearly, but soon after the 10th birthday we begin to review them more frequently to help optimize the timing of surgery. […] Close observation during this time period allows the patient and family to be presented with various treatment strategies.

• #34 Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification – Janssen – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/82552/html

  Pectus excavatum accounts for approximately 6595% of all chest wall deformities depending on the population being studied. Males are reported to be affected three to five times more often than females. No direct racial predisposition has been observed, although the deformity is more frequently described in Caucasians than among African Americans, Hispanics, or Asians. […] In literature, incidence rates of up to 8 per 1,000 live births have been reported. However, the true incidence and prevalence of pectus excavatum are not well-established yet and may be much higher than the currently described rates (up to 5% based on radiologic reports), as no large-scale, population-based studies have been conducted. Due to the absence of a clear definition of pectus excavatum and the key factor in diagnosing being visual examination, a well-founded estimation of the prevalence of the deformity is challenging. The dynamic nature of the deformity, which in most patients becomes more prominent and noticeable during early childhood and adolescence, further complicates determination of the number of cases in a population. Furthermore, there is still limited awareness of the deformity among the general population as well as healthcare providers, which may add to underreporting or misdiagnosing the deformity. […] While the global interest in pectus excavatum is currently higher than in pectus carinatum, which might reflect the real-world prevalence, the global trend in internet searches related to the topic pectus excavatum is decreasing each year.

• #35 Pectus excavatum from a pediatric surgeon’s perspective – Nuss- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/11847/12234

  Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. […] The overall incidence of familial pectus excavatum in our series is 40%. Genetic studies have been ongoing without identification of a specific gene but there is strong evidence of autosomal recessive genetic control. […] The male to female ratio has remained 4:1 in favor of boys throughout the last century. […] Although the incidence of congenital pectus excavatum can be debated, the more important question is at what age should one offer surgical repair in a patient with a severe pectus excavatum. […] At CHKD, we typically follow uncorrected patients yearly, but soon after the 10th birthday we begin to review them more frequently to help optimize the timing of surgery. […] Close observation during this time period allows the patient and family to be presented with various treatment strategies.

• #36 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Most cases of severe pectus excavatum are noticed at birth, with progressive worsening of the child’s growth and development. More than 80% of all cases are identified within the first 1-2 years of life. The condition typically becomes much more pronounced at puberty, during the time of rapid bone and cartilage growth. Most patients are brought to medical attention during their teenage years because of the significant change in the appearance of their chest.

• #37 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Most cases of severe pectus excavatum are noticed at birth, with progressive worsening of the child’s growth and development. More than 80% of all cases are identified within the first 1-2 years of life. The condition typically becomes much more pronounced at puberty, during the time of rapid bone and cartilage growth. Most patients are brought to medical attention during their teenage years because of the significant change in the appearance of their chest.

• #38 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Most cases of severe pectus excavatum are noticed at birth, with progressive worsening of the child’s growth and development. More than 80% of all cases are identified within the first 1-2 years of life. The condition typically becomes much more pronounced at puberty, during the time of rapid bone and cartilage growth. Most patients are brought to medical attention during their teenage years because of the significant change in the appearance of their chest.

• #39 Pectus Excavatum – MU Health Care

  https://www.muhealth.org/conditions-treatments/pediatrics/general-surgery/chest-wall-deformities/pectus-excavatum

  Pectus excavatum also known as sunken chest or funnel chest occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved-in or sunken appearance. It is the most common chest wall deformity, occurring in 1 in 400 births and found in 2.6% of 7- to 14-year-old children. […] Most kids begin showing symptoms of pectus excavatum during adolescence as their bones grow rapidly. […] Though it is typically a standalone condition, up to 20% of patients might have additional skeletal conditions, such as scoliosis.

• #40 Pectus Excavatum and Carinatum

  https://pediatricsurgery.wustl.edu/patient-care/congenital-and-pediatric-conditions/pectus-excavatum/

  Pectus deformities occur in one to eight in 1,000 people and are more frequent in boys than in girls. […] The deformity is often noticeable at birth but becomes more apparent during the period of rapid skeletal growth in early adolescence. […] The ideal age for surgical correction of this defect is anytime after two years of age, with the simplicity of repair in younger people making it the optimal period for repair. […] The standard pectus repair of these deformities has been to operate on both sides of the chest, put a plate behind the sternum and then perform a second operation to remove the plate after a year or so. […] The results of these operations are very good as far as enabling patients to participate in normal strenuous activities and athletics.

• #41 Pectus Excavatum: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1004953-overview

  Most cases of severe pectus excavatum are noticed at birth, with progressive worsening of the child’s growth and development. More than 80% of all cases are identified within the first 1-2 years of life. The condition typically becomes much more pronounced at puberty, during the time of rapid bone and cartilage growth. Most patients are brought to medical attention during their teenage years because of the significant change in the appearance of their chest.

• #42 Pectus Excavatum | Duke Health

  https://www.dukehealth.org/pediatric-treatments/pectus-excavatum

  Pectus excavatum is a disorder of the chest wall that appears as a depression in a child’s breastbone at the center of the chest. […] If your child has pectus excavatum, it is important to know that nearly all cases do not impact their growth, development, or activity level. Most cases of pectus excavatum do not have serious medical implications. […] Active surveillance is an important part of tracking all aspects of your child’s wellness. Our providers are trained in testing, monitoring, and treating a sunken chest. We involve you in all decisions about your child’s care and carefully explain our recommendations. […] Pectus excavatum can be identified in some toddlers but typically isn’t fully diagnosed until children are 10 to 13 years old.

• #43 Pectus Excavatum | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/pectus-excavatum

  Pectus excavatum is a deformity that occurs in approximately one out of 1,000 children. […] The disorder is about five times more common in boys than girls and is usually noted at birth as a mild condition but can become progressively more pronounced over time. […] Chest wall deformities can be evident in infancy, but many also develop or become more obvious as children grow. […] The optimal ages for chest wall deformity referrals are between 10 and 12 years.

• #44 Pectus Excavatum and Carinatum Repair – Pediatric Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/pediatric-surgery/clinical-services/pectus-excavatum-and-carinatum-repair

  Pectus deformities occur due to unusual growth of the rib cartilage, which can cause the chest to either sink inward or stick out. […] These conditions are more common than many realize, affecting about 1 in 300 people. […] While chest deformities may be visible at birth, they often become more noticeable during puberty. […] The severity can range from mild to severe. […] In moderate to severe cases, the rib cage may press against the heart and lungs, causing chest pain, breathing difficulties, fatigue, and reduced exercise tolerance.

• #45 Enhancing pectus excavatum diagnosis with an automated batch evaluation tool for chest computed tomography images | Scientific Reports

  https://www.nature.com/articles/s41598-024-73880-0

  Pectus excavatum (PE), the most prevalent congenital chest wall deformity, is characterized by a sunken sternum and adjacent costal cartilage, potentially causing cardiopulmonary compression, thereby, impacting the cardiopulmonary function of affected individuals. […] The HI, first proposed by Haller et al., is the most commonly adopted measurement index used for the diagnosis and evaluation of PE severity in clinical practice. […] A previous study set the cutoff point of the HI at 3.25 based on the observation that all patients undergoing corrective surgery in their study had a HI value3.252,3. […] Although the cutoff value lacks validation and varies across studies, it is widely adopted by most chest wall experts for PE evaluation. […] Another shortcoming of the HI is its poor discrimination.

• #46 Pectus Excavatum: Old Problem, Brief History, New Evidence

  https://oregonpediatricsociety.org/pectus-excavatum-old-problem-brief-history-new-evidence/

  As many as 1 in 400 people have pectus excavatum, a depression deformity of the chest. […] Commonly, those affected have not been offered work up or treatment; female patients are especially under diagnosed, as their breast tissue can make it difficult to assess the severity of the deformity. […] Surgical treatment is the gold standard for severe pectus excavatum. […] The Nuss procedure is now internationally accepted as the standard of care for correction of severe pectus excavatum. […] A Haller Index of 3.25 or higher defines a severe case of pectus excavatum. […] Patients with severe pectus excavatum are candidates for the Nuss procedure or MIRPE. […] In summary, there is a safe and effective treatment for teens and adults with pectus excavatum.

• #47 Enhancing pectus excavatum diagnosis with an automated batch evaluation tool for chest computed tomography images | Scientific Reports

  https://www.nature.com/articles/s41598-024-73880-0

  Pectus excavatum (PE), the most prevalent congenital chest wall deformity, is characterized by a sunken sternum and adjacent costal cartilage, potentially causing cardiopulmonary compression, thereby, impacting the cardiopulmonary function of affected individuals. […] The HI, first proposed by Haller et al., is the most commonly adopted measurement index used for the diagnosis and evaluation of PE severity in clinical practice. […] A previous study set the cutoff point of the HI at 3.25 based on the observation that all patients undergoing corrective surgery in their study had a HI value3.252,3. […] Although the cutoff value lacks validation and varies across studies, it is widely adopted by most chest wall experts for PE evaluation. […] Another shortcoming of the HI is its poor discrimination.

• #48 Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232575

  When we apply these same thresholds to the DHS1 cohort, we find that 0.5% have a Haller index 3.25 and 5% have a Correction index 10%. […] A higher prevalence is found in women (0.5%; 1 in 200) than men (0.3%; 1 in 333). […] In this study we estimate the prevalence of pectus excavatum at ~0.4%, or 1 in 250 individuals, in a large, population-based, multiethnic, adult population with a median age of 44 years.

• #49 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #50 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #51 Heart Disease and Pectus Excavatum: An Underestimated Issue—Single Center Experience and Literature Review

  https://www.mdpi.com/2075-1729/14/12/1643

  Pectus excavatum (PE) is the most common chest wall congenital deformity. The incidence is around 1 in 400 children, and it occurs four times more frequently in males than in females. […] Generally, it is an isolated congenital abnormality, but, rarely, concurrent congenital heart disease may be found in these patients. […] PE is common in patients with connective tissue disorders; in particular it has been observed in two-thirds of patients with Marfan syndrome (MS), an autosomal dominant disease that particularly affects the cardiovascular system. […] The aim of this study is to describe our experience of concurrent PE and cardiac disease, emphasizing the importance of surgical correction in symptomatic patients with a severe chest wall depression, causing cardiopulmonary complications secondary to the mechanical compression of the heart.

• #52 Pectus excavatum | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/pectus-excavatum?lang=us

  It accounts for 90% of chest wall deformities, occurring in up to 1 in 300-1000 births, more frequently seen in males (M:F = 3:1). […] Although most are sporadic it can be seen in association with: Marfan syndrome, Noonan syndrome, Ehlers-Danlos syndrome, neurofibromatosis type I, myotonic dystrophy, fetal alcohol syndrome, homocystinuria, osteogenesis imperfecta, congenital scoliosis, Poland syndrome, arterial tortuosity syndrome.

• #53 Pectus Excavatum – MU Health Care

  https://www.muhealth.org/conditions-treatments/pediatrics/general-surgery/chest-wall-deformities/pectus-excavatum

  Pectus excavatum also known as sunken chest or funnel chest occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved-in or sunken appearance. It is the most common chest wall deformity, occurring in 1 in 400 births and found in 2.6% of 7- to 14-year-old children. […] Most kids begin showing symptoms of pectus excavatum during adolescence as their bones grow rapidly. […] Though it is typically a standalone condition, up to 20% of patients might have additional skeletal conditions, such as scoliosis.

• #54 Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2017.021/html?lang=en&srsltid=AfmBOorovsGFGRbTU2bbpkwk_uDS8IaW_yiIpd7b-bYtkUeJa-iLUnwp

  Pectus deformities, including excavatum and carinatum, are among the most common congenital chest anomalies, with an overall incidence of pectus excavatum (PE) in 23 of 10,000 births. Pectus excavatum is more likely to occur in men than in women; however, female adolescents and women may be underdiagnosed because breast tissue could disguise the defect. […] Up to 43% of patients with PE have a family history of the condition. Pectus excavatum is thought to be of multifactorial inheritance, but the exact genes implicated are unknown. Pectus excavatum can be associated with scoliosis and connective tissue disorders such as Marfan syndrome, Ehlers-Danlos syndrome, and Noonan syndrome. One study found scoliosis incidence as high as 21% in patients with PE. […] With the increase in awareness of pectus deformities and the information available, more patients with uncorrected PE are seeking evaluation and treatment.

• #55 Enhancing pectus excavatum diagnosis with an automated batch evaluation tool for chest computed tomography images | Scientific Reports

  https://www.nature.com/articles/s41598-024-73880-0

  Pectus excavatum (PE), the most prevalent congenital chest wall deformity, is characterized by a sunken sternum and adjacent costal cartilage, potentially causing cardiopulmonary compression, thereby, impacting the cardiopulmonary function of affected individuals. […] The HI, first proposed by Haller et al., is the most commonly adopted measurement index used for the diagnosis and evaluation of PE severity in clinical practice. […] A previous study set the cutoff point of the HI at 3.25 based on the observation that all patients undergoing corrective surgery in their study had a HI value3.252,3. […] Although the cutoff value lacks validation and varies across studies, it is widely adopted by most chest wall experts for PE evaluation. […] Another shortcoming of the HI is its poor discrimination.

• #56 Pectus Excavatum | MUSC Health | Charleston SC

  https://musckids.org/our-services/surgery/chest-wall-deformity-center/pectus-excavatum

  Pectus excavatum occurs in 1 in 350 births with a male to female predominance of 3:1. […] Despite the lack of an identified genetic marker, there is a familial occurrence in at least 35% of cases. […] Several studies have shown changes in pulmonary function, primarily related to pulmonary reserve and ventilation volume. […] Other studies have suggested alterations in cardiac function, particularly with exercise.

• #57 Pectus Excavatum | MUSC Health | Charleston SC

  https://musckids.org/our-services/surgery/chest-wall-deformity-center/pectus-excavatum

  Pectus excavatum occurs in 1 in 350 births with a male to female predominance of 3:1. […] Despite the lack of an identified genetic marker, there is a familial occurrence in at least 35% of cases. […] Several studies have shown changes in pulmonary function, primarily related to pulmonary reserve and ventilation volume. […] Other studies have suggested alterations in cardiac function, particularly with exercise.

• #58 Heart Disease and Pectus Excavatum: An Underestimated Issue—Single Center Experience and Literature Review

  https://www.mdpi.com/2075-1729/14/12/1643

  In severe cases, the mechanical compression directly exercised by the depressed sternum on the heart may cause cardiac arrhythmias and severe, potentially life-threatening hemodynamic consequences, reducing stroke volume and cardiac output. […] In our case series, we reported the case of a 21-year-old patient with severe PE and a history of second-degree atrioventricular block type 1. […] The literature data are poor concerning the management of arrhythmia or cardiac arrest in PE patients, and little is known about the best treatment in these cases. […] However, lacking certain data regarding PE repair as a reversible cause of sudden cardiac arrest, according to the current European Society of Cardiology (ESC) guidelines, a S-ICD was implanted in our patient as a secondary prevention. […] PE is generally an isolated congenital chest wall abnormality, and its repair is usually performed for aesthetic reasons and psychosocial impact. However, the mechanical compression exerted by severe PE on the heart must not be underestimated in concomitant congenital or acquired cardiac disease.

• #59 SciELO Brazil – Cardiac anomalies in pediatric patients with pectus excavatum Cardiac anomalies in pediatric patients with pectus excavatum

  https://www.scielo.br/j/ramb/a/WS8G9YnyVhyJ9d3H7YHhJtQ/

  Pectus excavatum is the most prevalently encountered deformity of the thoracic wall. It can be accompanied by congenital anomalies. […] Our study showed that the prevalence of cardiac pathologies was higher in pediatric pectus excavatum patients than in healthy children in the control group. Thus, we recommend clinicians to refer pediatric pectus excavatum patients to pediatric cardiology outpatient clinics for the early diagnosis of potential cardiac pathologies. […] Congenital cardiac diseases are observed in 2% of pediatric PE patients. […] In our study, we found CHD in 3 (3.2%) patients: small secundum ASD that did not require intervention in one patient, and secundum ASD that required transcatheter closure in one patient and patent ductus arteriosus (PDA) in another patient. […] In agreement with the information in the literature, in our study, the PE group had significantly higher rates of cardiac pathology, cardiac malposition, MVP, MI, TVP, and CHD (p0.001, p0.001, p0.001, p0.001, p0.001, and p=0.027, respectively). Besides, when we conducted a risk analysis regarding MVP and TVP development in the PE patients using logistic regression analysis, we determined that the PE patients had a 16.56-fold increased risk of developing MVP and an 18.66-fold increased risk of developing TVP (p0.001 and p0.001, respectively).

• #60 SciELO Brazil – Cardiac anomalies in pediatric patients with pectus excavatum Cardiac anomalies in pediatric patients with pectus excavatum

  https://www.scielo.br/j/ramb/a/WS8G9YnyVhyJ9d3H7YHhJtQ/

  Pectus excavatum is the most prevalently encountered deformity of the thoracic wall. It can be accompanied by congenital anomalies. […] Our study showed that the prevalence of cardiac pathologies was higher in pediatric pectus excavatum patients than in healthy children in the control group. Thus, we recommend clinicians to refer pediatric pectus excavatum patients to pediatric cardiology outpatient clinics for the early diagnosis of potential cardiac pathologies. […] Congenital cardiac diseases are observed in 2% of pediatric PE patients. […] In our study, we found CHD in 3 (3.2%) patients: small secundum ASD that did not require intervention in one patient, and secundum ASD that required transcatheter closure in one patient and patent ductus arteriosus (PDA) in another patient. […] In agreement with the information in the literature, in our study, the PE group had significantly higher rates of cardiac pathology, cardiac malposition, MVP, MI, TVP, and CHD (p0.001, p0.001, p0.001, p0.001, p0.001, and p=0.027, respectively). Besides, when we conducted a risk analysis regarding MVP and TVP development in the PE patients using logistic regression analysis, we determined that the PE patients had a 16.56-fold increased risk of developing MVP and an 18.66-fold increased risk of developing TVP (p0.001 and p0.001, respectively).

• #61 Pectus Excavatum | Duke Health

  https://www.dukehealth.org/pediatric-treatments/pectus-excavatum

  Pectus excavatum is a disorder of the chest wall that appears as a depression in a child’s breastbone at the center of the chest. […] If your child has pectus excavatum, it is important to know that nearly all cases do not impact their growth, development, or activity level. Most cases of pectus excavatum do not have serious medical implications. […] Active surveillance is an important part of tracking all aspects of your child’s wellness. Our providers are trained in testing, monitoring, and treating a sunken chest. We involve you in all decisions about your child’s care and carefully explain our recommendations. […] Pectus excavatum can be identified in some toddlers but typically isn’t fully diagnosed until children are 10 to 13 years old.

• #62 Pectus excavatum from a pediatric surgeon’s perspective – Nuss- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/11847/12234

  Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. […] The overall incidence of familial pectus excavatum in our series is 40%. Genetic studies have been ongoing without identification of a specific gene but there is strong evidence of autosomal recessive genetic control. […] The male to female ratio has remained 4:1 in favor of boys throughout the last century. […] Although the incidence of congenital pectus excavatum can be debated, the more important question is at what age should one offer surgical repair in a patient with a severe pectus excavatum. […] At CHKD, we typically follow uncorrected patients yearly, but soon after the 10th birthday we begin to review them more frequently to help optimize the timing of surgery. […] Close observation during this time period allows the patient and family to be presented with various treatment strategies.

• #63 Pectus excavatum from a pediatric surgeon’s perspective – Nuss- Annals of Cardiothoracic Surgery

  https://www.annalscts.com/article/view/11847/12234

  Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. […] The overall incidence of familial pectus excavatum in our series is 40%. Genetic studies have been ongoing without identification of a specific gene but there is strong evidence of autosomal recessive genetic control. […] The male to female ratio has remained 4:1 in favor of boys throughout the last century. […] Although the incidence of congenital pectus excavatum can be debated, the more important question is at what age should one offer surgical repair in a patient with a severe pectus excavatum. […] At CHKD, we typically follow uncorrected patients yearly, but soon after the 10th birthday we begin to review them more frequently to help optimize the timing of surgery. […] Close observation during this time period allows the patient and family to be presented with various treatment strategies.

• #64 Pectus Excavatum: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17328-pectus-excavatum

  Pectus excavatum is the most common congenital (present at birth) abnormality that affects your chest wall. About 1 to 8 people per 1,000 have it. It happens more often in boys. […] Without a known cause of pectus excavatum, its difficult to pin down risk factors. Still, you may be at a higher risk for pectus excavatum if you have this condition in your family or have a syndrome linked to it. […] Regular checkups with a provider can help them decide when you should have an operation (or if your case is severe enough to need it). After surgery, youll need to see your surgeon on a regular basis until youve completely recovered.

• #65 Pectus Excavatum | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/pectus-excavatum/

  Pectus excavatum is more common in boys than girls. About 30% of children with pectus excavatum have another family member with a chest wall deformity. […] Pectus excavatum may also be associated with some underlying pulmonary conditions such as a diaphragmatic hernia or spinal muscular atrophy or rare connective tissue disorders and syndromes. […] The chest wall depression tends to get worse over time until late adolescence. […] We make a diagnosis of pectus excavatum based on your child’s physical exam and imaging results. […] The pediatric surgeons at Children’s Hospital Colorado are experienced in evaluating and treating pectus excavatum, both through surgery and through more conservative management.

• #66 Adult Chest Wall Deformities Clinic | University of Maryland School of Medicine

  https://www.medschool.umaryland.edu/surgery/divisions/division-of-thoracic-surgery/adult-chest-wall-deformities-clinic/

  Pectus excavatum is a congenital deformity of the bones and cartilage of the chest where several ribs and the breastbone (sternum) grow in an inward direction resulting in a sunken appearance of the center of the chest. […] While no one knows exactly what causes pectus excavatum, most people with the condition have had it since birth or early infancy and it is found to run in families. […] A physical exam and a detailed medical history are performed by a doctor to determine what symptoms may be attributable to the defect. […] Routine tests for adults include: X-ray, CT or MRI scan of chest, echocardiogram to test heart function, pulmonary function tests to check lung volume, exercise stress testing to measure exercise tolerance. […] Despite at times severe deformity it is possible to have no physiologic side effects. If that is the case our team will monitor your condition and repair only if it becomes necessary. […] The Nuss procedure offers the ability to return to normal activities sooner as the chest wall is still intact but sometimes pain can be an issue.

• #67 Adult Chest Wall Deformities Clinic | University of Maryland School of Medicine

  https://www.medschool.umaryland.edu/surgery/divisions/division-of-thoracic-surgery/adult-chest-wall-deformities-clinic/

  Pectus excavatum is a congenital deformity of the bones and cartilage of the chest where several ribs and the breastbone (sternum) grow in an inward direction resulting in a sunken appearance of the center of the chest. […] While no one knows exactly what causes pectus excavatum, most people with the condition have had it since birth or early infancy and it is found to run in families. […] A physical exam and a detailed medical history are performed by a doctor to determine what symptoms may be attributable to the defect. […] Routine tests for adults include: X-ray, CT or MRI scan of chest, echocardiogram to test heart function, pulmonary function tests to check lung volume, exercise stress testing to measure exercise tolerance. […] Despite at times severe deformity it is possible to have no physiologic side effects. If that is the case our team will monitor your condition and repair only if it becomes necessary. […] The Nuss procedure offers the ability to return to normal activities sooner as the chest wall is still intact but sometimes pain can be an issue.

• #68 Pectus Excavatum | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/pectus-excavatum

  Pectus excavatum occurs in approximately 1 out of 4001000 children and is three to five times more common in males than females. […] The surgical repair of pectus excavatum is a painful procedure. Length of stay in the hospital is determined primarily by pain control. […] Often, a pulmonary function study and cardiac evaluation (echo or cardiac stress test) are required as part of the preoperative evaluation in order to receive insurance approval.

• #69 Adult Chest Wall Deformities Clinic | University of Maryland School of Medicine

  https://www.medschool.umaryland.edu/surgery/divisions/division-of-thoracic-surgery/adult-chest-wall-deformities-clinic/

  Pectus excavatum is a congenital deformity of the bones and cartilage of the chest where several ribs and the breastbone (sternum) grow in an inward direction resulting in a sunken appearance of the center of the chest. […] While no one knows exactly what causes pectus excavatum, most people with the condition have had it since birth or early infancy and it is found to run in families. […] A physical exam and a detailed medical history are performed by a doctor to determine what symptoms may be attributable to the defect. […] Routine tests for adults include: X-ray, CT or MRI scan of chest, echocardiogram to test heart function, pulmonary function tests to check lung volume, exercise stress testing to measure exercise tolerance. […] Despite at times severe deformity it is possible to have no physiologic side effects. If that is the case our team will monitor your condition and repair only if it becomes necessary. […] The Nuss procedure offers the ability to return to normal activities sooner as the chest wall is still intact but sometimes pain can be an issue.

• #70 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #71 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #72 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #73 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #74 Pectus Excavatum | Duke Health

  https://www.dukehealth.org/pediatric-treatments/pectus-excavatum

  Pectus excavatum is a disorder of the chest wall that appears as a depression in a child’s breastbone at the center of the chest. […] If your child has pectus excavatum, it is important to know that nearly all cases do not impact their growth, development, or activity level. Most cases of pectus excavatum do not have serious medical implications. […] Active surveillance is an important part of tracking all aspects of your child’s wellness. Our providers are trained in testing, monitoring, and treating a sunken chest. We involve you in all decisions about your child’s care and carefully explain our recommendations. […] Pectus excavatum can be identified in some toddlers but typically isn’t fully diagnosed until children are 10 to 13 years old.

• #75 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #76 Pectus Program – About Pectus Excavatum | Texas Children’s

  https://www.texaschildrens.org/departments/pectus-program/pectus-excavatum

  Most patients are males, but females can also be affected. Many patients may have a relative with a chest wall deformity as well. Pectus excavatum may appear when a child is a baby, but shows most often during the pre-teen and teenage years. The defect can worsen as the child grows. […] Although some patients have no symptoms, most complain of shortness of breath and chest pain during exercise, but not at rest. As the deformity worsens, the symptoms usually worsen as well. Many patients with pectus excavatum say that they cannot keep up with their peers, or that they get tired much earlier than before the deformity was present. […] Patients may feel depressed or have anxiety issues. They might be embarrassed to go to the pool or beach with their friends or remove their shirt in front of people. Some patients may become loners and refuse to socialize.

• #77 Pectus Program – About Pectus Excavatum | Texas Children’s

  https://www.texaschildrens.org/departments/pectus-program/pectus-excavatum

  Most patients are males, but females can also be affected. Many patients may have a relative with a chest wall deformity as well. Pectus excavatum may appear when a child is a baby, but shows most often during the pre-teen and teenage years. The defect can worsen as the child grows. […] Although some patients have no symptoms, most complain of shortness of breath and chest pain during exercise, but not at rest. As the deformity worsens, the symptoms usually worsen as well. Many patients with pectus excavatum say that they cannot keep up with their peers, or that they get tired much earlier than before the deformity was present. […] Patients may feel depressed or have anxiety issues. They might be embarrassed to go to the pool or beach with their friends or remove their shirt in front of people. Some patients may become loners and refuse to socialize.

• #78 Pectus Excavatum and Carinatum Repair – Pediatric Surgery | UCLA Health

  https://www.uclahealth.org/medical-services/pediatric-surgery/clinical-services/pectus-excavatum-and-carinatum-repair

  Pectus deformities occur due to unusual growth of the rib cartilage, which can cause the chest to either sink inward or stick out. […] These conditions are more common than many realize, affecting about 1 in 300 people. […] While chest deformities may be visible at birth, they often become more noticeable during puberty. […] The severity can range from mild to severe. […] In moderate to severe cases, the rib cage may press against the heart and lungs, causing chest pain, breathing difficulties, fatigue, and reduced exercise tolerance.

• #79 Pectus Program – About Pectus Excavatum | Texas Children’s

  https://www.texaschildrens.org/departments/pectus-program/pectus-excavatum

  Most patients are males, but females can also be affected. Many patients may have a relative with a chest wall deformity as well. Pectus excavatum may appear when a child is a baby, but shows most often during the pre-teen and teenage years. The defect can worsen as the child grows. […] Although some patients have no symptoms, most complain of shortness of breath and chest pain during exercise, but not at rest. As the deformity worsens, the symptoms usually worsen as well. Many patients with pectus excavatum say that they cannot keep up with their peers, or that they get tired much earlier than before the deformity was present. […] Patients may feel depressed or have anxiety issues. They might be embarrassed to go to the pool or beach with their friends or remove their shirt in front of people. Some patients may become loners and refuse to socialize.

• #80 Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/10/1/e001665

  The review demonstrates that there are objective ways of measuring limitations in PEx and that they can be improved following surgery. […] This difference between rest versus exercise testing has led to contradictory results and what has been described as negative studies in some reports are in fact simply measuring the wrong outcomes. […] These demonstrated improvements in exercise testing indices have not yet been well correlated with patients symptoms which makes their clinical significance uncertain in terms of meaningfully outcomes for patients. […] What is clear, however, is the psychological impact that surgery can have. In almost all studies that measured it, symptom burden and QoL of patients with PEx improved significantly following surgery and the rate of satisfaction was high, generally greater than 90%. […] The recent decision by the NHS to decommission surgery for PEx is likely to hamper efforts to conduct such a study and has far-reaching implications for patients with PEx.

• #81 Pectus Excavatum – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430918/

  Reported prevalence has been 1/300 to 1/1000 live births; with a 5:1 male to female ratio. Pectus excavatum constitutes 90% of all chest wall deformities. Most defects are appreciated within the first year of life, with severe deformities present at birth. The funnel – formed chest tends to become more pronounced during the pubertal growth spurt. Pectus excavatum may present as an isolated anomaly or as a part of a multitude of congenital disorders. Amongst these clinical syndromes, connective tissue disorders are rarely (less than 1%) associated with pectus excavatum. […] Overall, congenital chest wall defects are rare. As the most common defect, pectus excavatum can be appreciated on physical examination by health care providers at every level. Pediatricians are well equipped to follow these patients, and determine the need for comprehensive cardiopulmonary assessment. There is a misconception that pectus chest wall deformities are merely cosmetic defects, even in the absence of abnormal pulmonary function and cardiac testing. Asymptomatic patients or those with minor defects may not need any treatment, be offered physical therapy consultation, or can be considered for negative pressure therapy. Surgical (pediatric or cardiothoracic) consultation should be sought for all patients with a Haller Index of 2.5 or greater, as well as for patients with concomitant cardiac defects that need surgical repair or decreased pulmonary reserve. Regardless of the Haller index measure, impaired cardiopulmonary function is an indication for surgical correction. Surgical correction of the funnel chest attributed to a pectus excavatum defect significant improves pulmonary function at rest and VO2 max in cases in which the Haller index measures greater than 3.2. Subjective improvements tracked by quality measurements have also been attributed to operative correction.

• #82 Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/10/1/e001665

  The review demonstrates that there are objective ways of measuring limitations in PEx and that they can be improved following surgery. […] This difference between rest versus exercise testing has led to contradictory results and what has been described as negative studies in some reports are in fact simply measuring the wrong outcomes. […] These demonstrated improvements in exercise testing indices have not yet been well correlated with patients symptoms which makes their clinical significance uncertain in terms of meaningfully outcomes for patients. […] What is clear, however, is the psychological impact that surgery can have. In almost all studies that measured it, symptom burden and QoL of patients with PEx improved significantly following surgery and the rate of satisfaction was high, generally greater than 90%. […] The recent decision by the NHS to decommission surgery for PEx is likely to hamper efforts to conduct such a study and has far-reaching implications for patients with PEx.

• #83 Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/10/1/e001665

  The review demonstrates that there are objective ways of measuring limitations in PEx and that they can be improved following surgery. […] This difference between rest versus exercise testing has led to contradictory results and what has been described as negative studies in some reports are in fact simply measuring the wrong outcomes. […] These demonstrated improvements in exercise testing indices have not yet been well correlated with patients symptoms which makes their clinical significance uncertain in terms of meaningfully outcomes for patients. […] What is clear, however, is the psychological impact that surgery can have. In almost all studies that measured it, symptom burden and QoL of patients with PEx improved significantly following surgery and the rate of satisfaction was high, generally greater than 90%. […] The recent decision by the NHS to decommission surgery for PEx is likely to hamper efforts to conduct such a study and has far-reaching implications for patients with PEx.

• #84 Outcomes in adult pectus excavatum patients undergoing Nuss repair | PROM

  https://www.dovepress.com/outcomes-in-adult-pectus-excavatum-patients-undergoing-nuss-repair-peer-reviewed-fulltext-article-PROM

  There are very few major publications that documented symptoms and quality-of-life improvement after Nuss repair in adult patients. […] The extension of the Nuss procedure to repair adults with PEx has been controversial in the past. […] There are now multiple publications that report successful repair of adults even beyond 50 years of age. […] Adequate surgical experience with the Nuss procedure in younger patients that are easier to repair is critical prior to attempting the more difficult adult deformity. […] There is enough evidence to validate repair of adults with PEx. Published data support the benefits of repair with good outcomes and improvement of symptoms.

Zobacz więcej