What is Pectus Excavatum (Founder’s Chest)?

Pectus excavatum is a congenital disease that causes the chest to have a sunken or hollow appearance. It is the most common congenital chest wall abnormality in children. You can find more information below.

What is pectus excavatum?

Pectus excavatum , also known as shoemaker ‘s chest , is a condition in which a person’s breastbone sinks into their chest. In severe cases, the center of the chest may appear to be hollowed out, leaving a deep pit.

A sunken sternum is usually noticed shortly after birth, while the severity of shoestring breast typically worsens during the growth spurt of puberty.

Pectus excavatum (shoemaker’s chest) is more common in boys than girls. In severe cases, this condition can interfere with the function of the heart and lungs. However, even in mild cases, it can cause serious deformities in children’s appearance. Surgery can correct the deformity.

What causes pectus excavatum?

The exact cause of shoemaker’s chest is unknown, but it can be an inherited condition as it sometimes runs in families.

Who is at risk?

Pectus excavatum (shoemaker’s chest) is more common in boys than girls. It is also more common in people who have:

  • Marfan syndrome
  • Ehlers-Danlos syndrome
  • Osteogenesis is imperfect
  • Noonan syndrome
  • Turner syndrome
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What are the symptoms of pectus excavatum?

For many people with shoestring breasts, the only symptom is a slight indentation in their chest. In some people, the depth of the indentation worsens during early adolescence and may continue to worsen into adulthood.

In severe cases, the sternum can compress the lungs and heart. Signs and symptoms may include:

  • Decreased exercise tolerance
  • rapid heartbeat or palpitations
  • recurrent respiratory infections
  • wheezing when breathing
  • Cough
  • chest pain
  • heart murmur
  • Tiredness
  • dizziness

How is pectus excavatum diagnosed?

Shoemaker’s chest can usually only be diagnosed by examining the chest. Your doctor may recommend several different types of tests to check for problems with the heart and lungs. These tests may include:

  • Chest X-ray: The X- ray can visualize the collapse of the sternum and usually shows the heart displacing towards the left side of the chest. This procedure is painless and takes only a few minutes to complete.
  • Computed tomography (CT): A CT scan may be used to help determine the severity of the shoemaker’s chest and whether the heart or lungs are compressed. CT scans take many X-rays from various angles to produce cross-sectional images of the body’s internal structure. You may be asked to undergo a special CT that looks at the effects of compression on the heart as you breathe in and out.
  • Electrocardiogram: An electrocardiogram can show whether the heart’s rhythm is normal or irregular and whether the electrical signals that control the heartbeat are timed correctly. This test is painless and involves placing more than a dozen electrical wires attached to the body with an adhesive.
  • Echocardiogram: Echocardiogram is the sonogram of the heart. It can show real-time images of how well the heart and its valves are working. Images are produced by transmitting sound waves through a rod pressed against the chest. The echocardiogram also gives your doctor a look at how the chest wall can affect heart function and blood flow from the heart.
  • Lung function tests: These types of tests measure the amount of air your lungs can hold and how quickly you can empty your lungs.
  • Exercise test: This test monitors how well your heart and lungs are working, usually while exercising on a bike or treadmill.
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How is pectus excavatum treated?

Shoemaker’s chest can be repaired with surgery, but surgery is usually preferred for people with moderate to severe symptoms. Physical therapy may be helpful for people with mild symptoms. Some exercises can improve posture and increase the degree of expansion of the chest.

If your breastbone deformity isn’t causing any symptoms but you’re not happy with the way it looks, you can talk to a surgeon about placing a silicone insert – similar to a breast implant – under your skin to fill in that gap.

Repair surgery

The two most common surgical procedures for repairing a shoemaker’s chest are known by the names of the surgeons who first developed them:

  • Nuss procedure: This minimally invasive procedure uses small incisions placed on either side of the chest. Long-handled instruments and a narrow fiber optic camera are inserted through the incisions. An inclined metal rod is threaded under the depressed breastbone to raise it to a more normal position. In some cases more than one rod is used. The bars are removed after two or three years.
  • Ravitch technique: These older procedures involve a much larger incision down the middle of the chest. The surgeon removes the deformed cartilage that connects the ribs to the lower breastbone and then fixes the breastbone in a more normal position with surgical equipment such as a metal brace or mesh braces. These supports are removed in six to 12 months.

Most people who have surgery to correct their pectus excavatum (shoemaker’s chest) condition are satisfied with the change in the appearance of their breasts, no matter what procedure is used. Although most surgeries are performed around the adolescent growth spurt, many adults have also benefited from this repair.

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Temporarily freezing the nerves to block pain (cryoablation) can aid healing and reduce post-operative pain for four to six weeks.

What are the complications of pectus excavatum?

Severe cases of shoestring chest can compress the heart and lungs or push the heart to one side. It can cause appearance problems even in mild cases.

heart and lung problems

If the depth of the sternum indentation is severe, it can reduce the amount of room the lungs have to expand. This condition also compresses the heart, pushing it towards the left side of the chest, reducing its ability to pump effectively. This can cause symptoms such as exercise intolerance, shortness of breath, rapid heart rate and chest pain.

appearance problems

Most people with pectus excavatum (shoemaker’s chest) are dissatisfied with their appearance. Usually, they try to cover up the appearance of the body in various ways. However, this can be corrected with surgery.

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