Pectus excavatum is a disease in which the center of the chest collapses to form a funnel such as those used in natural science experiments and at home. It is believed that "costal (rib) cartilage grows faster than the sternum and ribs, so the middle of the sternum collapses because it cannot maintain a balance and bows to pressure from either side," but the pathogenesis is not yet clear. It may tend to be three to four times more prevalent among males than females.

Pectus excavatum is hereditary (domestic emergence); some children are born with it congenitally, while others develop it gradually. In childhood, it may accompany enlarged tonsils or hypertrophy of adenoids, and taking a deep breath due to the narrow pathway for air causes this collapse.

Pectus excavatum may be improved by performing surgery for enlarged tonsils or hypertrophy of adenoids in advance. Many children who are diagnosed with Pectus excavatum are leptosome, having a flat chest and underdeveloped muscles and naturally tend to hunch over to breathe more easily, which leads to scoliosis (curvature of the spine) in many cases. The symptoms of diagnosed children indicates that breathing is compromised by the heart being pushed to the left, which may cause rapid heartbeats or breathlessness during exercise, as well as proneness to fatigue, frequent respiratory infections, and arrhythmia, because the collapse of Pectus excavatum is essentially progressive.

　■　Medical treatment of Pectus Excavatum

Methods of treatment can be divided into roughly three categories.

[1]Sternum Elevation Procedure

*This is also called the Ravitch technique, named after Dr. Ravitch, who developed it.
This technique abates deformed costal cartilage that tend to cause collapse by cutting and excising the back of the sternum in wedge shape and placing external costal cartilage on the remaining internal costal cartilage, and then securing them with sutures. In the case of adult patients, it is necessary to support the chest wall from beneath by implanting a metal plate for assistance. There have been reports that indicate fixation of the sternum takes time, large scars remain, this surgery can only improve Pectus excavatum to flat chest, and re-collapse occurs at a high rate.

*Costal cartilage ablation method (Sternocostal elevation technique)
This method is to ablate an elongated part of the third or fourth costal cartilage to the seventh costal cartilage and re-suture to the sternum. This is performed for all pediatric cases and for all adults other than those with severe collapse.

Although it has frequently been observed that the technique of largely ablating costal cartilage and rebuilding only part of the rib or costal cartilage restrains chest development, this technique is free from such anxiety. Re-collapse is also rare, because excessively long parts of the rib or costal cartilage are directly cut off. However, collapse can become highly visible due to excessively long ribs during adolescent growth spurts. Deformation of the chest may become apparent as height rapidly increases during adolescence, because patients with Pectus excavatum tend to be tall and slender, especially in cases of males.

[2]Sternal Rotation Procedure
This method is to resect the collapsed portion of the sternum from the chest wall and suture them after rotation, which has a long history in Japan and is also common throughout the world. There is also a so-called Pedunculated Sternal Rotation technique in which the rectus abdominis and internal thoracic arteriovenous remain. Some people claim that the risk is too high for patients in terms of a minimally invasive surgery.

[3]Chest Way Procedure
This technique is the newest development among these three procedures. As a type of Sternum Elevation Procedure, it elevates and restores the chest to an ideal shape by inserting a plate for two to three years without ablating costal cartilage. The sternum is elevated and supported by a technique of inserting a 12- to 15-mm?wide metal plate, which has been inflected into the shape of the chest desired after surgery, between the heart/lungs and the chest wall along the back of the sternum through a 15- to 25-mm small incision in the flank while checking the pleural space with a thoracoscope, a so-called endoscope, and rotating it 180 degrees behind the sternum. The plate is placed on both sides of the ribs and is stabilized by an attached stabilizer that prevents detachment.