Ask Mayo Clinic: My 14-year-old can't keep up on the soccer field. Could pectus excavatum be why?

AdviceThis Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org. (Tribune News Service)Tribune News ServiceDear Mayo Clinic: My 14-year-old son recently started his fall soccer season and has been having trouble keeping up with teammates. He gets short of breath and tires more quickly than he used to. He was recently diagnosed with pectus excavatum, and his doctor said this is likely causing his symptoms. What are the treatment options, and how do we know if he needs surgery? If he does need surgery, what does the procedure and recovery involve?Answer: Pectus excavatum is a condition in which the breastbone, or sternum, is sunken into the chest. The condition is often noticeable shortly after birth, but it can become more pronounced during the rapid growth that occurs around puberty.For some children and teens, pectus excavatum is primarily a cosmetic concern. For others, particularly those with a more significant depression of the breastbone, the condition can compress the heart and lungs and affect how well they function. Symptoms can include shortness of breath, chest pain, fatigue, a rapid or pounding heartbeat, and decreased endurance during physical activity.That means an experience like your son’s — having more difficulty keeping up during soccer or another sport — can be an important reason to have the condition evaluated. However, shortness of breath during exercise can have many causes, so it’s important to determine whether pectus excavatum is responsible for his symptoms.An evaluation typically begins with a physical exam. Additional testing can help determine the severity of the condition and whether the heart or lungs are affected. Depending on the person, testing may include a chest X-ray or other imaging, an electrocardiogram, an echocardiogram, lung function tests or an exercise function test.Not every child with pectus excavatum needs surgery. For children with mild pectus excavatum, physical therapy exercises may help improve posture and increase how much the chest can expand. Another nonsurgical option for some children and younger teens is sternal suction, sometimes called vacuum bell therapy. A cup- or bell-shaped device is placed over the breastbone and uses suction to gently pull it forward. The device typically needs to be used regularly over many months.Surgery is generally considered for patients with moderate to severe symptoms. For teens who need surgery, the most common operation is the Nuss procedure, which is a minimally invasive technique.During the Nuss procedure, the surgeon makes small incisions on each side of the chest and uses a tiny camera and surgical instruments to place a curved metal bar underneath the breastbone. The bar is then rotated, lifting the breastbone into a more typical position. Some patients may need more than one bar to reposition the breastbone. The bar usually remains in place for two to three years while the chest remodels itself, then it’s removed.Pain management is an important part of recovery. At Mayo Clinic, we use cryoablation during surgery to temporarily freeze nerves in the chest wall that transmit pain. The effects can last for weeks while the chest heals. This approach has significantly changed recovery after pectus excavatum surgery and reduced the need for opioid pain medication. Many patients at Mayo Clinic are able to walk the day of surgery and go home the following day.After surgery, patients need time to heal before returning to strenuous activity and sports. Your son’s surgical team would provide specific instructions about activity restrictions and when he could safely return to soccer or other activities.Pectus excavatum can affect more than physical health. Adolescence is a time when young people can be particularly self-conscious about their appearance, and a noticeable difference in chest-wall shape can affect body image and self-esteem. These concerns are also important to discuss with your child’s healthcare team.The severity and effects of pectus excavatum can vary widely from person to person. Treatment decisions are based on several factors, including symptoms, the degree of chest-wall deformity and whether the condition is affecting heart or lung function. While many children and teens with pectus excavatum don’t need surgery, a range of nonsurgical and surgical treatment options is available for those who experience significant symptoms or other concerns.— D. Dean Potter Jr., M.D., Pediatric Surgery, Mayo Clinic, Rochester, MinnesotaMayo Clinic Q&A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit...