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Pectus excavatum

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One of the most common major anomalies of childhood.

The most common type of congenital chest wall abnormality accounting for 90% of such abnormalities.

Estimated 1 in 300-400 births.

More than 90% of cases are diagnosed within the first year of life.

Males are affected six times more often than females.

Recognized in infancy and becomes more severe with adolescence, and remains constant throughout adult life.

Symptoms become increasingly severe during adolescence causing fatigue, dyspnea, impaired endurance, chest pain, and tachycardia.

Associated with problems of self-esteem and psychological distress.

The growth of bone and cartilage in the anterior chest wall is abnormal and typically affects 4-5 ribs on each side of the sternum.

The defect varies from mild to very severe cases.

No known genetic defect is responsible for the development of pectus excavatum.

Familial occurrence reported in 35% of cases.

Associated with Marfan syndrome and Poland syndrome.

Many patients are asymptomatic.

Cardiac function is usually normal, but mitral valve prolapse has been reported in 20-60% of cases.

Echocardiography may reveal atrial compression and cardiac displacement.

Mprevalent in whites.

The heart is deviated to the left chest and has associated reduction in stroke volume.

Lung expansion is limited and causes a restrictive defect.

Repair is recommended for symptomatic patients with open repair with cartilage resection.

Surgery is usually performed after the age of 10 years and optimally between 12 and 19 years, and 97% of patients have a good-excellent result.

Minimally invasive (Nuss repair) avoids cartilage resection and takes less operating time.

Nuss repair is associated with more pain, longer hospitalization, and more complications than with cartilage resection.

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