Non-surgical treatment for pectus excavatum and carinatum

Abstract

Pectus excavatum (PE) and carinatum (PC) are characterized by an abnormal overgrowth of sternal and costal cartilages, which result in a depression or protrusion of the sternum and costal cartilages, respectively. Both chest wall malformations are cosmetic and functional pathologies. Whereas PE is commonly associated to cardiopulmonary dysfunction, PC causes deformation of the entire thoracic cage. PE is generally corrected operatively. In contrast, due to inherent risks of a major surgery, only severe cases of PC are operated. One of the authors (FMH) will describe his 12 years experience with vacuum bells to treat PE patients conservatively. The use of vacuum bells allow significant lift of the ribs and sternum, until definitive correction of cartilage growth takes place. When employed during minimally invasive repair of PE (MIRPE), vacuum bells can also be used as a tool to enhance retrosternal dissection, advancement of the pectus introducer and insertion and flipping of the pectus bar/s. The other author (MMF) will describe his 13 years experience with the FMF® Dynamic Compressor System to treat patients with PC conservatively. When considering results, there should be little doubt that no patient would be selected as a candidate for surgery before trying a non-operative approach. Further evaluation and follow-up studies are still necessary for both conservative approaches, though.