Congenital depression of the anterior chest wall is known as pectus excavatum. This is caused by overgrowth of the cartilage between the ribs and the sternum (breastbone), pushing the sternum inward. The heart is compressed and often shifted into the left side of the chest. Individuals may have limitation of physical activity, including shortness of breath, chest pain, inability to keep up with peers, and fatigue.
The diagnosis is made by physical examination and chest imaging. Cardiac magnetic resonance imaging (MRI) is the most effective at demonstrating the degree of heart compression as well as the chest wall deformity.
Surgery is recommended for relief of symptoms and improvement of chest wall contour. For older adolescents and adults, correction by sternal eversion produces excellent long-term relief of symptoms and preservation of chest wall shape. In this operation, the sternum is turned over and repositioned, using the natural concavity of the breastbone to relieve the cardiac compression and re-form the anterior chest wall. After healing, exercise tolerance is increased and the shape of the chest is much improved.