Pectus Excavatum

1. 3D PRINTING IN CHEST
WALL PATHOLOGIES
Marcelo C. DaSilva, MD, FACS
Division of Thoracic Surgery - Brigham and Women’s Hospital. Boston, MA
Harvard Medical School

2. Pectus Excavatum
Marcelo C. DaSilva, MD, FACS

3. Pectus Excavatum
•Most common congenital sternal deformity
–1 in 400 children
•Excessive growth of lower costal cartilage resulting in
sternal depression
•Deeper depression on the right, pushing heart to the
left
•Congenital with progressive worsening over time
•Rarely familial
Marcelo C. DaSilva, MD, FACS

4. Physiologic Manifestations
•Usually asymptomatic
•“Subjective” decrease in respiratory reserve
with exercise
•Scoliosis and mitral valve prolapse have been
associated with pectus excavatum
•Mild restrictive pattern on PFTs has been
documented in some studies
•Decreased stroke volume and CO during
upright exercise has also been demonstrated
Marcelo C. DaSilva, MD, FACS

5. Operative Indications
•Cosmetic correction is the most common
reason
•Psycho-social factors, however, may be quite
limiting, particularly in older children and
teenagers
•Respiratory insufficiency and recurrent
pulmonary infections
•Best results are obtained in patients between
the ages of 3 and 5
Marcelo C. DaSilva, MD, FACS

6. Operative Technique
Ravitch repair
1.Midline or transverse infra-mammary incision
2.Pectoralis reflected bilaterally to expose costal
cartilages
3.Subperichondrial resection of all deformed costal
segments
4.Elevate sternum from underlying structures and
separate from cartilage
5.Transverse sternal osteotomy and fixation with pin or
cartilage support
Marcelo C. DaSilva, MD, FACS

7. Results
•Cosmetic results are good in 80-90%
•Recurrence occurs in about 10-20% of
patients
•Return of normal respiratory function and
improvement in exercise capacity is
possible
Marcelo C. DaSilva, MD, FACS

8. 3D & New Technique for Repair
of Pectus Excavatum in Adults
•43-yo referred for a 2
nd
opinion for pectus
excavatum
•SOB, DOE progressive worse past 2 years
•CT scan: severe excavatum with AP diameter of
4.5 cm at the xyphoid
–displacement of the heart.
•FVC 3.18 (88%) FEV1 1.33 (45%) DLCO: 18.74
Marcelo C. DaSilva, MD, FACS

9. Stress Echo
•Left Ventricle: segmental left ventricular wall
motion abnormalities present
–Wall motion abnormality involves the septal location
•Tricuspid Valve – Resting
–There is color and spectral Doppler evidence of
severe tricuspid regurgitation
Marcelo C. DaSilva, MD, FACS

10. Pre-op CT-scan
•Haller index: 5.8 (2.5)
–Significant pectus excavatum has an index greater than 3.25.
•The Correction Index: 52%
Marcelo C. DaSilva, MD, FACS

11. Marcelo C. DaSilva, MD, FACS

12. Pre-op 3D Planning
Marcelo C. DaSilva, MD, FACS

13. Surgery
Marcelo C. DaSilva, MD, FACS

14. PRE-OP POST-OP
Marcelo C. DaSilva, MD, FACS

15. Marcelo C. DaSilva, MD, FACS

16. A. STL FILE OF CHEST WALL AND MASS B. PLANNED RESECTION
Potential applications of 3D printing
Marcelo C. DaSilva, MD, FACS

17. The world is in perpetual motion, and we
must invent the things of tomorrow…
Act with audacity.” Madame Clicquot
Marcelo C. DaSilva, MD, FACS