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Concave Chest In Teens

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MIAMI (Ivanhoe Newswire) - Can you imagine being a teenage boy, living at the beach, and not having enough confidence to take your shirt off and not having enough energy to even take a walk? The condition is called concave chest. One-in-500 kids will be born with it.

Just last year, even yoga was too exhausting for Thomas Luongo.

“I couldn’t do any strenuous activity because you could see my heart beating through my skin,” Luongo told Ivanhoe.

Thomas suffered from pectus excavatum, or concave chest. His chest was sinking in, pressing on his lungs and his heart, and zapping his energy and his confidence.

“People would be like, 'oh I can eat cereal out of your chest,'” Luongo explained.

Pediatric surgeon Cathy Burnweit used a metal bar to remodel Luongo's chest.

“It’s basically putting a metal bar under the sternum and it remodels the sternum, much like braces,” Cathy Burnweit, MD, Chief of Pediatric Surgery, Miami Children's Hospital, told Ivanhoe.

Doctors cut a small incision on both sides of Luongo's chest. The bar is tunneled under the skin, underneath the breast bone, and is then rotated and the breast bone is pushed out.

“We usually do the procedure as the child enters puberty and so they go through their growth spurt with the bar in place,” Dr. Burnweit explained.

The chest will remodel over the course of three to four years. Before this surgery, doctors had to perform open chest surgery, remove the cartilages, break the sternum, and then let the bones re-heal. The recovery time was months. With the bar procedure, Luongo was able to leave in five days and was back to daily activities in just one month.

“I feel a lot better [and] I feel healthier,” Luongo said. “I’ve gained weight and I feel better about myself.”

Dr. Burnweit said the bar is taken out in three to four years. A smaller number of kids suffer from a condition called pectus carinatum, or pigeon chest, where the chest bulges out. It is easily treated with a brace.

RESEARCH SUMMARY

BACKGROUND: Pectus excavatum, also called sunken or funnel chest, is a congenital chest wall malformation where several ribs and the sternum grow abnormally, creating a concave or caved-in appearance of the anterior chest wall and sternum. It occurs in an estimated one in 300 to 500 births, affecting mostly males. The condition is usually noticed at birth and more than two-thirds of cases are diagnosed within the first year of life. (Source: http://emedicine.medscape.com/article/1970203-overview)

SYMPTOMS: Worsening of the chest’s appearance and the onset of symptoms are usually reported during rapid bone growth seen in puberty and early teenage years. For many people, their only sign is a slight indentation in their chests. In some people, the depth of the indentation worsens in early adolescence and can continue to worsen into adulthood. In severe cases, the breastbone may compress the lungs and the heart. Signs include:

  • Decreased exercise tolerance
  • Rapid heartbeat or heart palpitations
  • Recurrent respiratory infections
  • Wheezing or coughing
  • Chest pain (Source: mayoclinic.com)

NUSS: The Nuss technique was originally described by Dr. Nuss. Nuss performed the first minimally invasive operation for the correction of pectus excavatum in the eighties. It wasn’t until 1997 that the new and innovative technique introduced to the American Pediatric Surgical Association. The current recommendations support the use of the Nuss technique in patients aged five to twenty years. The ideal age for undergoing the operation has been established at eight to twelve years because the chest wall is still very malleable, stabilization of the bar is easily achieved, thoracic epidural can be safely placed, and the child is mature enough to understand the operation and postoperative instructions. (Source: http://emedicine.medscape.com/article/1970203-overview#aw2aab6b2b2)

FOR MORE INFORMATION, CONTACT:

Cathy Burnweit, MD
Chief, Department of Pediatric Surgery
Fellowship Director
Miami Children's Hospital

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