Chest wall anomalies affect health in a variety of ways. In order to provide a complete evaluation and create a comprehensive care plan, we often enlist the help of other specialists. Here are some of the consultations we may request, and why:
Chest wall anomalies “run in families” and have a strong underlying genetic basis. Some are associated with specific genetic syndromes, such as Marfan Syndrome, although in most cases the genetic basis is not known. It is important that these be identified since some genetic syndromes have health implications beyond pectus. In addition, the surgical approach to correction of some chest wall abnormalities may be altered if an underlying genetic syndrome is present.
Some chest wall anomalies affect the heart and it is important to know if heart function is impaired. In particular, pectus excavatum causes the heart to shift from the middle of the chest to the left side, impinges on the right side of the heart and decreases heart function. This may limit exercise and have long term consequences. Pectus excavatum also is associated with mitral valve prolapse. Repair of pectus excavatum acts to reverse these problems.
Some chest wall anomalies alter lung function. In particular, pectus excavatum restricts expansion of the lungs and decreases lung function. Shortness of breath with exercise may be noted. Pectus carinatum may also affect lung functions. When chest wall anomalies are associated with fused ribs and/or curvature of the spine, very significant impairment of lung function my result (thoracic insufficiency syndrome). Correction of the anomaly often improves lung function. In addition, some patients with pectus abnormalities may have a separate lung problem such as asthma. Pulmonology evaluation can help us identify these other problems.
Some chest wall anomalies require complex surgical repair that involves plastic surgery. In some such cases, poor or absent development of the breast and underlying muscles requires breast augmentation/reconstruction.
Chest wall anomalies may be associated with curvature of the spine (scoliosis). If the curvature is significant it should be corrected by bracing or surgery. If fused ribs are present, correcting the spine curvature may be done with separation of the fused ribs.
Surgical correction of pectus excavatum often involves placement of one or more bar-like implants. These are made from stainless steel which contains nickel. Nickel allergy is quite common and must be excluded before placement of a stainless-steel bar. If a nickel allergy is present, implants made of titanium are used.
Certain chest wall anomalies, notably pectus carinatum, may be effectively treated with bracing rather than surgery. Although “off-the-shelf” braces are available, custom made braces offer optimum treatment.