The correction of pectus excavatum in children using a minimally invasive technique

Funnel chest (pectus excavatum) represents a deformity of the sternumand the costal cartilages in children, which becomes progressivelyworse without treatment. Moreover, a deep depression in theanterior chest may cause respiratory, cardiovascular and psychologicalcomplications for the child thus affected. The operation proposedby Marc Ravitch (in 1949) became the model for correction ofcongenital chest deformities for about 50 years and consists of resectingthe malformed cartilages and of reconstructing the sternumby a wedge osteotomy. In 1997, Donald Nuss presented the resultsof correction of the deformity with the aid of a stainless steel barplaced under the sternum, using thoracoscopic visulalization. Thisbar raises the sternum and the curved cartilages in a convex fashionand places a temporary prop to maintain the normal appearance ofthe anterior chest wall. We present eight operations (in 7 patients)using this technique. The presentation includes a description of theoperative technique and the short and medium-term results as wellas a comparison with the results of other authors using the sametechnique.