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 Center for Pectus Excavatum and Pectus Carinatum

The Center for Pectus Excavatum and Pectus Carinatum at the Tulane Hospital for Children is a leading referral center dedicated to the treatment of pediatric and adolescent anomalies of the chest wall including Pectus Excavatum and Pectus Carinatum.  Our facility offers a multi-disciplinary team approach for the treatment and surgical management of patients with Pectus Excavatum and Pectus Carinatum including nurses, physical therapists, child-life specialists, dieticians, social workers, and surgeons that specialize in pediatric and adolescent thoracic procedures.  Our goal is to meet the full spectrum of health care needs for patients who suffer from Pectus deformities. 

Why a Pectus Specialist?  

Effective diagnosis and treatment of Pectus Excavatum and Pectus Carinatum requires a cardiothoracic specialist, with the support of pediatric cardiologists and other medical staff that specialize in the care of chest wall deformities.    Dr. Thomas Yeh, an internationally recognized pediatric cardiothoracic surgeon and Medical Director of The Center for Pectus Excavatum and Pectus Carinatum, works in tandem with the Pediatric Heart Center and the other services of the Tulane Hospital for Children to provide the complete spectrum of care for pediatric and adolescent patients needing care for chest wall deformities and cardiac related issues.  



Pectus Excavatum

Pectus excavatum affects approximately one in every 1,000 children and is the most common type of chest wall malformation. Pectus excavatum occurs when an overgrowth of cartilage connected to the ribs pushes the breast bone inward causing a depression in the chest. Children are born with this chest wall malformation, but its symptoms become more noticeable and worsen as the child develops physically. Symptoms may be difficult to recognize in very small children but they often include physical limitations such as shortness of breath, decreased stamina (inability to exercise and play for long periods of time), chest wall pain, and cardiac displacement.  Older children with pectus excavatum are often self-conscious about the appearance of their chest and may suffer from social anxiety in certain situations as a result. 

Diagnosis

Before pectus excavatum can be properly treated the extent of the chest wall malformation needs to be identified. Dr. Yeh and the staff of the Center for Pectus Excavatum and Pectus Carinatum will conduct a comprehensive physical examination and may request several tests, including a pulmonary function test, cardiac echocardiography, and an imaging study such as a chest x-ray or CT scan.   

Treatment

The type of treatment for pectus excavatum depends upon the extent of the malformation and the severity of the symptoms that the patient is experiencing.  In some cases surgery may be recommended in order to improve the patient’s respiratory capacity, cardiac function, posture, or physical appearance.  If surgery is required the most common methodology for correcting pectus excavatum is referred to as the Nuss Procedure.This minimally invasive (laparoscopic) procedure reshapes the chest wall by placing a thin, curved, custom-made stainless steel bar under the sternum; the center of the bar rests behind the sternum and the curvature of the bar presses against the breastbone, effectively reshaping the chest. In order to place the bar in the appropriate position very small incisions are made on each side of the chest, underneath the arms, through which the bar is placed and affixed. While the correction occurs very quickly the steel bar is left in place for approximately 2 years in order to support the chest and allow the chest wall to heal into its new shape (the bar is not visible from the outside).  Once healing is complete the bar is removed in an outpatient procedure.  

Healing

The average hospital stay is 5 days, and may vary depending upon the age and overall health status of the patient. Physical therapy begins the day after surgery to teach the patient and family caregivers proper ways to walk, sit and move in order to speed recovery. Children can return to school within two weeks and can return to driving (if of driving age) within 6 weeks.  Restrictions on participation in sports and other physical activities varies by level of participation; Dr. Yeh will discuss these in detail during your consultation.   


Travel after surgery

Some patients fly or travel long distances by car to receive care at the Center.  After discharge the patient can travel by either mode of transportation but may need occasional stops if traveling by car, or assistance in the airport if the flight requires a layover.

 

Pectus Carinatum

Pectus carinatum is a deformity of the chest wall in which the sternum and rib cartilage protrude outward. It is less common than other chest wall deformities and occurs more often in boys than in girls.  Typically the deformity becomes much more visible as the child enters the high growth period of adolescence. 

Diagnosis 

Pectus carinatum does not usually present the patient with physical limitations but in some cases, as the deformity becomes more pronounced in adolescence, compression on the sides of the chest resulting from protrusion may cause problems with breathing or lung capacity and may result in lack of stamina or chest pain.  The deformity can also contribute to social anxiety in some situations.  The initial consultation will include a physical evaluation of the chest by Dr. Yeh; additional diagnostic tests such as exercise testing and x-rays may be recommended.  

Treatment

Historically, surgery was the only option available to correct pectus carinatum but today this defect can be repaired through the use of orthotic bracing as well.  The treatment approach that is chosen will be determined by the age of the patient, the results of the comprehensive physical examination, and consultation with the patient.

  • Orthotic Bracing - custom made orthotic bracing is a nonsurgical innovation for the treatment of pectus carinatum.  After evaluation by Dr. Yeh a certified orthotist will design a custom-fitted chest brace which consists of form fitting front and back compression plates anchored to aluminum struts and bound together by adjustable straps on each side.  The painless brace is designed to apply continuous pressure on the protruding breastbone and return it to a normal position. The chest brace is easily hidden under loose-fitting clothing and must be worn 14-16 hours per day for a minimum of two years or until the child has stopped growing (the brace may require adjusting at predetermined intervals).  Most patients will see significant improvement within a few months. After the initial brace fitting the patient will need to return to the Center for a follow-up appointment after six weeks and again at 6-12 month intervals over the course of treatment.
  • Surgery – In some cases surgery may be chosen as the treatment option for pectus carinatum.  The extent of the procedure is determined by the severity and symmetry of the deformity.  To make the correction an incision is made across the chest and the deformed cartilage is removed.  The sternum is then repositioned and the incision is closed with dissolvable sutures.  During the healing period the cartilage will re-grow and the chest will assume a normal appearance.   

Healing 

The average hospital stay is 3 – 5 days and may vary depending upon age, overall health status, and amount of postoperative pain that is experienced by the patient.  Restrictions on participation in sports and other physical activities varies by level of participation; Dr. Yeh will discuss these in detail during your consultation.

Travel after surgery

Some patients fly or travel long distances by car to receive care at the Center.  After discharge the patient can travel by either mode of transportation but may need occasional stops if traveling by car, or assistance in the airport if the flight requires a layover.

 

Dr. Thomas Yeh

Dr. Thomas Yeh is an internationally recognized pediatric cardiothoracic surgeon who specializes in the treatment of pediatric and adolescent Pectus Excavatum and Pectus Carinatum.  He is a Professor in the Departments of Surgery and Pediatrics at the Tulane University School of Medicine and is the Director of the Pediatric Heart Center at the Tulane University Hospital for Children.
 


Thomas Yeh, M.D., PhD

Elias Hanna Professor and Chair of Cardiothoracic Surgery

Chief, Division of Cardiothoracic Surgery

Chief, Pediatric Heart Center

Chief, Pediatric Cardiothoracic Surgery

Director, Center for Pectus Excavatum and Pectus Carinatum


Education

MD, The Johns Hopkins University School of Medicine, Baltimore, MD

PhD, The Medical College of Virginia, Richmond, VA

BS, Duke University

Residency & Fellowships

Pediatric Cardiothoracic Surgery, The Hospital for Sick Children, Toronto, ON

Cardiothoracic Surgery, The Medical College of Virginia, Richmond, VA

General Surgery, The Medical College of Virginia, Richmond, VA

Certification

American Board of Thoracic Surgery


Contact Us / Make an Appointment

To schedule an appointment with Dr. Yeh please call our Patient Concierge at (504)-988-2273.   The Center for Pectus Excavatum and Pectus Carinatum at the Tulane Hospital for Children is conveniently located in the Medical District of New Orleans, between the Central Business District and the French Quarter.  

 

 

Tulane University, Department of Surgery, 1430 Tulane Ave. SL-22 New Orleans, LA 70112 504-988-5128 surgery@tulane.edu