HISTORICAL ASPECTS OF PECTUS EXCAVATUM

Abstract

Pectus excavatum (PE), also known as "funnel chest," is the most common congenital malformation of the chest wall, with historical references dating back to ancient Egypt. This article explores the historical evolution of PE, tracing its recognition, terminology, and medical interpretations over time. Early descriptions emerged in the 16th century, with significant developments in understanding its etiology and treatment occurring in the 19th and 20th centuries. Various hypotheses have been proposed regarding its causes, ranging from genetic predisposition to diaphragmatic contracture and skeletal abnormalities. The surgical treatment of PE has evolved from early attempts at costal cartilage resection to modern minimally invasive techniques, particularly the Nuss procedure. This review highlights key historical milestones, influential figures in the field, and the progressive refinement of surgical interventions that have shaped the current approach to managing pectus excavatum.

Keywords:

Pectus excavatum, Historical review, Thoracic surgery

References

Hohmann D. On the surgical treatment of funnel chest according to Brunner. Arch. Orthop. Unfallchir. 1960. 51:422-7.

Phillips J.R. Funnel chest: Report of case successfully treated by chondro-sternal resection. Dis. Chest. 1944. 10(5):422-6.

Ochsner J.L., Ochsner A. Funnel chest (chonechondrosternon). Surg. Clin. North Am. 1966. 46(6):1493-500.

Dean C., Etienne D., Hindson D., Matusz P., Tubbs R.S., Loukas M. Pectus excavatum (funnel chest): a historical and current prospective. Surg. Radiol. Anat. 2012. 34(7):573-9.

Pawlak K., Dyszkiewicz W. A historical outline of surgical treatment for congenital chest wall deformities. Kardiochirurgia i Torakochirurguia Polska. 2013. 10(2):182-5.

Brodkin H.A. Congenital chondrosternal depression (funnel chest) relieved by chondrosternoplasty. Am. J. Surg. 1948. 3:716-20.

Brown A.L. Pectus excavatum (funnel chest): anatomic basis; surgical treatment of the incipient stage in infancy; and correction of the deformity in the fully developed stage. J. Thorac. Surg. 1939. 9:164-84.

Bialas A.J., Kaczmarski J., Kozak J., Kempinska-Miroslawska B. Pectus excavatum in relief from Ancient Egypt (dating back to circa 2400 BC). Interact. CardioVasc. Thorac. Surg. 2015. 20:556-7.

Kwiecinski J. Pectus excavatum in mummies from ancient Egypt. Interact. CardioVasc. Thorac. Surg. 2016. doi:10.1093/icvts/ivw249.

Tóth G.A., Buda B.L. Funnel chest (pectus excavatum) In 10-16th century fossilmaterial. J. Paleontol. 2001. 13: 63-6.

Ashrafian H. Leonardo da Vinci and the first portrayal of pectus excavatum. Thorax. 2013. 68(11):1081.

Lazzeri D., Nicoli F. Pectus excavatum in paintings by Jusepe de Ribera (1591-1652). Thorax. 2016. 71(7):669-70.

Jackson J.L., George R.E., Hewlett T.H., Bowers W.F. Pectus excavatum. Surgical experiences in thirty-four case. Am. J. Surg. 1959. 98:664-76.

Brochhausen C., Turial S., Muller F. Pectus excavatum: history, hypotheses and treatment options. Ann. Thorac. Surg. 2012. 14:801-6.

Williams C.T. Congenital malformation of the thorax: Great depression of the sternum. Tr. Path. Soc. London. 1872. 24:50.

Woillez E. Sur un cas de difformité thoracique considerable avec déplacement inoffensif de plusieurs organes et signes stéthoscopiques particuliers. L’Union Méd. J. Int. Corp Med. 1860. 6:515-21.

Zuidema W.P. Minimally invasive repair of pectus excavatum. PhD-Thesis - Research and graduation internal. Vrije Universiteit Amsterdam. 2020.

Grifin E.H., Minnis J.F. Pectus excavatum: a survey and a suggestion for maintenance of correctionj. Thor. Surg. 1957. 33(5):625-36.

Ochsner A., DeBakey M. Chone-chondrosternon. Report of a case and review of the literature. J. Thor. Surg. 1939. 8(5):469-511.

Davis W.C., Berley F.V. Pectus excavatum and pectus carinatum; report on the surgical treatment of eleven patients. Am. J. Surg. 1956. 91(5):770-6.

Kelly R.E. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operatio. Semin. Pediatr. Surg. 2008. 17:181-93.

Lester C.W. Funnel chest and allied deformities of the thoracic cage. J. Thor. Surg. 1950. 19(4):507-22.

Schulz-Dost S., Syed J., Luber A.M., Carbon R., Besendorfer M. From pullout-techniques to modular elastic stable chest repair: the evolution of an open technique in the correction of pectus excavatum. J. Thorac. Dis. 2019. 11(7):2846-60.

Nuss D., Obermeyer R.J., Kelly R.E. Nuss bar procedure: past, present and future. Ann. Cardiothorac. Surg. 2016. 5(5):422-33.

Yildiran H., Sunam G.S. The 100 most-cited articles on pectus deformities: A bibliometric analysis. Turkish J. Thorac. Cardiovasc. Surg. 2021. 29(2):223-32.

Giem R.N., Paulsen G.A., Dykes J. Pectus deformities. Calif. Med. 1961. 94(5):306-9.

Dorner R.A., Keil P.G., Schissel D.J. Pectus excavatum; case report with pre- and postoperative angiocardiographic studies. J. Thorac. Surg. 1950. 20(3):444-53.

Rehbein F., Wernicke H.H. The operative treatment of the funnel chest. Arcg. Dis. Child. 1957. 32(161):5-8.

Lindskog G.E., Felton W. Considerations in the surgical treatment of pectus excavatum. Ann. Surg. 1955. 142(4):654-9.

Haller J.A., Peters G.N., Mazur D., White J.J. Pectus excavatum. A 20 year surgical experience. J. Thor. Cardiovasc. Surg. 1970. 60(3):375-83.

Sweet R.H. Pectus excavatum. Report of two cases successfully operated upon. Ann. Surg. 1944. 119(6):922-34.

Ravitch M.M. The operative treatment of pectus excavatum. Ann. Surg. 1949. 129(4):429-44.

Ravitch M.M. Technical problems in the operative correction of pectus excavatum. Ann. Surg. 1965. 162(1):29-33.

Humphreys G.H., Jaretzki A. Pectus excavatum. Late results with and without operation. J. Thorac. Cardiovasc. Surg. 1980. 80:686-95.

Shamberger R.C., Welch K.J. Surgical repair of pectus excavatum. J. Pediatr. Surg. 1988. 123(7):615-22.

Wada J., Ideda K., Ishida T. Results of 271 funnel chest operations. Ann. Thorac. Surg. 1970. 10(6):526-32.

Hawkins J.A., Ehrenhaft J.L., Doty D.B. Repair of pectus excavatum by sterna eversion. Ann. Thorac. Surg. 1984. 38(4):368-73.

Dailey J.E. Repair of funnel chest using sub sterna osteoperiosteal rib graft strut of a case with four year follow-up. JAMA. 1952. 150(12):1203-4.

Adkins P.C., Blades B.A. Stainless steel strut for correction of pectus excavatum. Surg. Gynecol. Obstet. 1961. 113:111-3.

Welch K.J. Satisfactory surgical correction of pectus excavatum deformity in childhood; a limited opportunity. J. Thorac. Surg. 1958. 36(5): 697-713.

Stanger P.W., Robicsek F., Daugherty H.K. The repair of recurrent pectus excavatum. J. Cardiovasc. Surg. 1968. 56(1):141-3.

Marks M.W., Argenta L.C., Lee D.C. Silicone implant correction of pectus excavatum: indications and refinement in technique. Plast. Reconstr. Surg. 1984. 74(1):52-8.

Margulis A., Sela M., Neuman R., Buller-Sharon A. Reconstruction of pectus excavatum with silicone implants. J. Plast. Reconstr. Aesthet. Surg. 2005. 59(10):1082-6.

Snel B.J., Spronk C.A., Werker P.M., van der Lei B. Pectus excavatum reconstruction with silicone implants: long-term results and review of the English-language literature. Ann. Plast. Surg. 2009. 62(2):205-9.

Martinez, D., Juame, J., Stein, T. et al. The effect of costal cartilage resection on chest wall development. Pediatr Surg Int . 1990. 5:170-3.

Haller J.A., Colombani P.M., Humphries C.T., et al. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann. Thorac. Surg. 1996. 61:1618-25.

Nuss D., Kelly R.E., Croitoru D., Katz M.E. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J. Pediatr. Surg. 1998. 33:545-52.

Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin. Pediatr. Surg. 2008. 17:209-17.

Biatas A.J., Kempinska-Miroslawska B. Minimally invasive repair of pectus excavatum (the Nuss procedure) in Poland and worldwide – a summary of 25 years of history. Kardiochirurgia i Torakochirurgia Polska. 2013. 10(1):42-7.

Haecker F.M., Sesia S. Vacuum bell therapy. Ann. Cardiothorac. Surg. 2016. 5(5):440-9.

Li G., Jiang Z., Xiao H., Wang M., Hu F. et al. A novel modified Nuss procedure for pectus excavatum: A new steel bar. Ann. Thorac. Surg. 2015. 99:1788-92.

Rodriguez-Granillo R.A., Toselli L., Farina J., Raggio I., Diluca P. et al. Usefulness of strain cardiac magnetic resonance for the exposure of mild left ventricular systolic abnormalities in pectus excavatum. J. Pediatr. Surg. 2022. 57:319-24.