More Adults Seeking Surgical Repair of Under-Treated Congenital Chest Deformity

32-year-old Tim Alexander was born with a common defect called pectus excavatum (PE), also known as a "sunken or concave" chest. PE is by far the most common major congenital chest deformity, occurring in approximately 1 in every 400 births.

While growing up, Alexander recalled feeling self-conscious about his sunken chest, to the point where he dreaded taking off his shirt during sports or swimming. When his parents asked doctors about fixing the defect, they were told not to bother because surgical repair was "too messy" and unnecessary.

However, by age 30, Alexander's symptoms had worsened. He was experiencing strong heart palpitations, constantly feeling lethargic and suffering from breathing difficulties. He decided that it was time to "go for it," and underwent surgery at UCLA Medical Center to repair his sunken chest.

A new study shows that Alexander is among a growing number of adult patients - aged 19 years and older - who are getting their PE or pectus carinatum (PC -- where the chest cavity is pushed outward) defect corrected because of persistent and often worsening symptoms. The findings of this comprehensive UCLA study are published in the September issue of Annals of Surgery and were also presented at the annual meeting of the American Surgical Association in April 2000.

"More than ever, we are seeing adults who never received treatment during their childhood, usually because they were told that surgical repair was dangerous and minimally effective," commented Dr. Eric Fonkalsrud, professor of surgery at UCLA and principle investigator of the study.

"However, during the past five years with the revolutionary new concept of minimally invasive techniques, and the availability of several informative PE websites on the Internet, more patients -of all ages- have become aware that their deformities can be corrected successfully," added Fonkalsrud, who has been performing pectus repair surgeries for more than 35 years.

The study examined the records of all patients, 19 years and older, who underwent correction of PE or PC deformities at UCLA Medical Center from January 1969 through December 2001. During this 32-year period, 545 patients underwent repair of their PE defect while 99 patients underwent repair for their PC deformities.

During the last 15 years, 116 of the patients were age 19 or older (average age was 30 years); 106 of those patients had surgery within the past six years. Eighty-six patients reported that they sought repair after reviewing information about PE deformities on the Internet.

The study concluded that although the procedure is technically more difficult in adults than in children, pectus deformities could be repaired in older patients with low morbidity, a short hospital stay and with very good physiologic and cosmetic results.

The majority of patients with PE are diagnosed during the first year of life. Inward depression usually becomes much more severe during the period of rapid skeletal growth in early adolescence. With PC, deformities are often unrecognized until adolescent skeletal growth occurs. The majority of both types of deformities remain with the same severity throughout adult life after the person is full-grown.

According to Fonkalsrud, data shows that many patients who do not undergo repair of severe pectus chest in their childhood will experience worsening symptoms in adult life, including shortness of breath with mild exercise, progressive loss of stamina and endurance with physical activity and heart palpitations.

The surgical procedure itself takes an average of 3 hours. Patients remain hospitalized for about 3 days and return to work or school within 2 weeks. A sternal support bar, implanted during surgery, is removed about 6 months later in an outpatient surgical procedure that takes less than 30 minutes.

The study found that approximately 97 percent of the 116 adult patients interviewed considered the results of their surgical repair to be very good or excellent, and that they would recommend the repair of pectus deformities to other patients.

"Overall, the whole surgical experience wasn't bad and the scarring has been minimal," said Alexander. "But best of all, it has been a big boost to my self-esteem."