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Pectus carinatum is usually not associated with other serious genetic disorders or syndromes. At times, some children may have another connective tissue disorder, such as Marfan's syndrome. Major genetic work-ups, with multiple tests and consultations, are usually not indicated when evaluating pectus carinatum patients.
Some children with pectus carinatum are asymptomatic. Others can develop shortness of breath with exertion, chest pain, recurrent respiratory infections, or asthma. Others may have significant psychological issues, with self-esteem problems and embarrassment concerning the unusual appearance.
The first course of treatment is bracing. Many children with flexible, growing chest bones and cartilage are excellent candidates for non-operative management of this condition using external compression bracing. Since 2006, pediatric surgeons at WakeMed have provided this treatment in collaboration with local prosthetics professionals. The brace can be custom-fit to the child and worn beneath clothing. Typically, bracing should be the initial treatment offered to the child. With this approach, surgery can be avoided in about 70 percent of cases.
If bracing does not correct the condition, surgery can be considered. Some children fail to respond to external bracing because the chest tends to "stiffen up" during adolescence and becomes less malleable. Other children are poor candidates for bracing due to asymmetry, when one side of the chest sticks forward much more than the other side. Surgical repair of symptomatic pectus carinatum that has failed compression therapy is usually performed to help improve breathing, decrease respiratory infections and decrease chest wall pain.
After the child is given general anesthesia, the surgeon makes two small lateral incisions on each side of the chest. Using a thoracoscope (small diameter telescope) to visualize the chest, a C-shaped bar is inserted subcutaneously through two small lateral incisions. The bar is located at the point of maximum protrusion. It is placed in front of the sternum and fixed in a compressing position to the ribs on either side. The bar is normally removed after two to three years during an outpatient procedure.
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