Pectus Excavatum

Author: Fawwaz Shaw, MD
Institution: University of Washington
Date Reviewed: May 2014
Learning Domain: General Thoracic
Learning Objective: Chest Wall
PowerPoint File: Pectus Excavatum

Discussion Points for Conference

• Evaluation of Pectus Excavatum
• Indications for repair
• Surgical options and their complications

Haller Score

Pectus Severity Index (Haller score)

• Internal width of the lower chest divided by the distance from the posterior sternum to the spine.
• Normal score: 2.56

Indications for repair

• 2 or more of the following criteria:
  • PSI > 3.25  or CT evidence of cardiac/pulmonary  compression
  • Cardiac evaluation demonstrating cardiac compression, displacement, Mitral prolapse, or conduction abnormalities
  • Pulmonary evaluation demonstrating restrictive/obstructive lung disease
  • Failed prior repair
  • Psychosocial impact.

Learning points

• Evaluation of Pectus Excavatum requires pulmonary, cardiac and exercise testing.
• Psychosocial impact of the deformity may be an indication for repair
• Common operations include the modified Ravitch procedure and the Nuss procedure.
• Each have similar rates of recurrences (<1.5%) with less long term pain associated with the modified Ratvich procedure.