Key Points

• Pectus excavatum is the most common of the congenital chest wall deformities.
• Pectus deformities result from abnormal costal cartilage growth.
• Open repair techniques are modifications of the original Ravitch technique differing only in the amount of cartilage removed and the stabilizing techniques employed.
• The Nuss procedure is a minimally invasive procedure that relies on cartilage remodeling rather than resection.

The congenital anterior chest wall deformities encompass a wide variety of abnormalities. They range in severity from minor cosmetic defects to life-threatening conditions with cardiopulmonary compromise. Although the diagnosis is readily made by examination, the indications for and timing of surgical intervention remain controversial in all but the most dramatic cases. Included among these abnormities are pectus excavatum, pectus carinatum, Poland’s syndrome, and sternal clefts.