1. Minimally Invasive Pectus Excavatum Repair: The Nuss Procedure
Dr Osama Bawazir
FRCSI, FRCS(Ed), FRCS (glas), FRCSC.

2. Overview of Pectus Excavatum
Incidence
Associated Anomalies
Investigation
Methods of Repair
Outcome

3. Chest Wall Deformities
Pectus Excavatum
Pectus Carinatum
Poland’s Syndrome
Sternal Defects
Thoracic Dysplasia

4. Pectus Excavatum Incidence: 1/1000 children (depending on criteria)
Etiology: Typically idiopathic (80%)
Associated MSK defect (20%)
Scoliosis (most common)
Poland’s syndrome
Marfan’s, CP, CDH
Cardiac Defects (2%)

5. Pectus Excavatum: Clinical Presentation
Evident at birth (80%)
Deformity worsens with URTI
Moderate and severe deformities associated with decreased exercise tolerance

6. Pectus Excavatum: Evaluation
History and Physical
CT Scan (Index: Transverse/AP)
Pulmonary Function Studies
Echocardiogram Treatment:
Mild: (CT index < 3) exercise and clavicle strap
Moderate/severe: (CT index > 3) operate IF:
Patient Motivated
Functional Impairment

7. Pectus Excavatum: Surgical Options
Open Repair (Ravitch)
Repair of cartilaginous portion of ribs, preserving perichondrium
Closed Repair (Nuss)
Insertion of corrective bar (See Video)

8. Nuss procdure
Intrathoracic bar implantation (controlled by thoracoscopy)
Correction of sternum and funnel without resection of rips or cartilage
Influence on the costo-sternal joints
From Nuss - original paper