Pectus excavatum in the adult: Current treatment modalities

Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages accounting for more than 90% of congenital chest wall deformities.^1,2 With inward compression and decreased chest volume, PE can be more than a cosmetic deformity. Severe cases frequently result in exercise intolerance and physiologic cardiopulmonary impairment. Often patients with PE are dismissed by their physicians as having an inconsequential cosmetic problem. This misconception has resulted in many patients reaching adulthood with uncorrected severe defects. With the advent of internet-based information sources and the lure of less invasive repair techniques, many adult patients with uncorrected PE are now seeking surgical repair. There is some evidence that a true physiologic impairment associated with the defect may worsen as the patient ages. Cardiopulmonary symptoms may develop in the adolescent; however, others may only develop symptoms with aging. The physiologic data documenting improved cardiopulmonary function and psychosocial function after repair in adults is limited by small sample sizes. Although many studies and a meta-analysis now support repair of PE in the adolescent, only a few studies in adults document physiologic impairment. This chapter reviews the available adult literature regarding treatment of PE in the adult patient.