DEAR MAYO CLINIC: We've noticed an indent in our son's chest since he was about 6 years old. Our pediatrician diagnosed this as pectus excavatum but said that it was nothing to worry about. Six years later, he's starting to complain that his heart is racing, and he experiences loss of endurance and shortness of breath with exercise. We are very concerned and wondering if we need another opinion. I've heard surgery may be necessary for these children. What does surgery to treat pectus entail? And how do we know when it's time?
ANSWER: Understandably, having a child with a physical difference brings concern, especially when it progresses to affect quality of life. Pectus excavatum is the most common congenital chest wall anomaly in the U.S. Families do notice the sunken breastbone when children are very young; however, most kids do not have problems with the anomaly until they are teenagers. Symptoms are likely to develop after a growth spurt when the indentation can become deeper due to abnormal growth of the chest wall cartilage. Additionally, when children become more active in sports, this often unmasks the exercise intolerance associated with pectus excavatum.
The most common symptoms we see with pectus excavatum are chest wall pain around the anomaly, exercise intolerance or avoidance, shortness of breath while exercising, and early fatigue with exercise. Certainly, the cosmetic effects of the indentation are of great concern, but the physiologic consequences are very real and most important when we begin to think about surgical correction of pectus excavatum.
