Surgical Repair of Pectus Arcuatum

Abstract

Background

Pectus arcuatum, a very rare variant (chondromanubrial) of the carinatum chest wall deformity, occurs due to premature fusion of the sternal ossification centers causing obliteration of the manubrio-sternal joint. Typically, patients undergo surgical repair for cosmetic purposes. This study reviews the clinical experience using titanium plate systems for surgical repair of pectus arcuatum.

Methods

The records of our prospective Chest Wall Deformities Clinical Database since September 2018 include 27 pectus arcuatum patients. The patients aged 17 and older were evaluated for corrective surgery (n = 24, 16 male, 8 female, mean age: 24.9 years). The hybrid surgical technique included wedge osteotomy of the most protruded part of the sternum, excision of the associated costochondral junctions followed by placement of two parallel titanium plates to secure the sternum, and insertion of an excavatum bar (n = 7) if there is a significant depression at the sternal body. Follow-up outpatient visits were every 3 to 6 months.

Results

All of the patients tolerated the surgery very well. The mean length of the surgery was 118 minutes. The mean hospital length of stay was 5.6 days. One patient experienced pericardial and right pleural effusion 2 weeks after surgery, which was resolved by anti-inflammatory treatment. The mean time to return to daily activity was 12 days. The mean follow-up was 42 months. All patients indicated the postoperative results as very good or excellent.

Conclusion

Repair of arcuatum deformity can be performed in adults with low morbidity, short hospital stay, and satisfactory cosmetic results even in complex cases.

Keywords

pectus excavatum - carinatum - chest wall - sternum

Note

This study has been presented at the 24^th Annual Congress of the Chest Wall International Group (CWIG), Phoenix, Arizona, October 23–25, 2024.

Publikationsverlauf

Eingereicht: 17. März 2025

Angenommen: 24. Juni 2025

Accepted Manuscript online:
26. Juni 2025

Artikel online veröffentlicht:
07. Juli 2025

• References

• 1 Shamberger RC, Welch KJ. Surgical correction of chondromanubrial deformity (Currarino Silverman syndrome). J Pediatr Surg 1988; 23 (04) 319-322
• 2 Ravitch MM. Unusual sternal deformity with cardiac symptoms operative correction. J Thorac Surg 1952; 23 (02) 138-144
• 3 Currarino G, Silverman FN. Premature obliteration of the sternal sutures and pigeon-breast deformity. Radiology 1958; 70 (04) 532-540
• 4 Gritsiuta AI, Bracken A, Beebe K, Pechetov AA. Currarino-Silverman syndrome: diagnosis and treatment of rare chest wall deformity, a case series. J Thorac Dis 2021; 13 (05) 2968-2978
• 5 Chidambaram B, Mehta AV. Currarino-Silverman syndrome (pectus carinatum type 2 deformity) and mitral valve disease. Chest 1992; 102 (03) 780-782
• 6 Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009; 21 (01) 44-57
• 7 Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin 2010; 20 (04) 563-574
• 8 Fokin AA. Pouter pigeon breast. Chest Surg Clin N Am 2000; 10 (02) 377-391
• 9 Robicsek F, Watts LT, Fokin AA. Surgical repair of pectus excavatum and carinatum. Semin Thorac Cardiovasc Surg 2009; 21 (01) 64-75
• 10 Önen A, Agababaoglu I, Sanlı A, Karaçam V, Ersöz E, Özdemir N. A new surgical approach for mixed-type pectus carinatum: the Onen procedure. Turk Gogus Kalp Dama 2014; 22 (04) 878-883
• 11 Kuzmichev V, Ershova K, Adamyan R. Surgical correction of pectus arcuatum. J Vis Surg 2016; 2 (02) 55
• 12 Kara M, Gundogdu AG, Kadioglu SZ, Cayirci EC, Taskin N. The use of sternal wedge osteotomy in pectus surgery: when is it necessary?. Asian Cardiovasc Thorac Ann 2016; 24 (07) 658-662
• 13 Kim SY, Park S, Kim ER, Park IK, Kim YT, Kang CH. A case of successful surgical repair for pectus arcuatum using chondrosternoplasty. Korean J Thorac Cardiovasc Surg 2016; 49 (03) 214-217
• 14 Leng S, Bici K, Facchini F. et al. Customized cutting template to assist sternotomy in pectus arcuatum. Ann Thorac Surg 2019; 107 (04) 1253-1258
• 15 Soria-Gondek A, Oviedo-Gutiérrez M, Martín-Lluís A, López de Castro P, de Diego M. Modified Ravitch procedure and autologous cartilage graft for pectus arcuatum. Ann Thorac Surg 2022; 114 (02) e105-e107
• 16 Gonzalez-Barbba I, Lain A, Garcia L, Gine C, Lopez M. Pectus arcuatum: description of a hybrid surgical technique. J Ped Surg Open 2023; 3 (October): 100030
• 17 St-Louis E, Laberge JM, Wissanji H, Emil S. A minimally invasive hybrid procedure to correct pectus arcuatum. J Plast Reconstr Aesthet Surg 2024; 93: 127-132
• 18 Yuksel M, Lacin T, Ermerak NO, Sirzai EY, Sayan B. Minimally invasive repair of pectus carinatum. Ann Thorac Surg 2018; 105 (03) 915-923
• 19 Notrica DM, McMahon LE, Jaroszewski DE. Pectus disorders: excavatum, carinatum and arcuatum. Adv Pediatr 2024; 71 (01) 181-194
• 20 Zeineddine RM, Farina JM, Shawwaf KA. et al. Surgical treatment and outcomes of pectus arcuatum. JTCVS Tech 2024; 28: 194-202