Does Pectus Carinatum Affect the Heart?

Being the parent or caregiver of a child with pectus carinatum can be quite worrying. While the physical appearance of this condition means that aesthetic concerns often predominate, other potential health impacts — particularly on lung or heart function, are also of concern.

This article will discuss the impact of pectus carinatum on the heart, including the following questions: Does pectus carinatum affect heart development? Does it affect heart function? What other consequences can pectus carinatum have on your child’s health? And how can the effects of pectus carinatum be corrected or prevented? To find out more, read on!

About Pectus Carinatum Chest Wall Deformity

Pectus carinatum is known by a variety of names, such as pigeon breast, pigeon chest, and pouter pigeon breast. However, they all refer to a congenital condition that results in overgrowth of the breastbone cartilage, leading to the breastbone protruding abnormally from the rest of the chest. 

Although the exact causes are unclear, most isolated cases of pectus carinatum appear to be from a combination of genetic and environmental factors.[1,2] In addition, pectus carinatum may occur as a side effect or secondary symptom of a number of congenital conditions or syndromes, such as:

• Ehlers-Danlos syndrome
• Homocystinuria
• Marfan syndrome
• Multiple lentigines syndrome
• Morquio syndrome
• Noonan syndrome
• Osteogenesis imperfecta
• Trisomy 18
• Trisomy 21 (Down syndrome)

Among all cases of chest wall deformities, pectus carinatum is relatively common, accounting for around 15% of chest wall deformities.[3] In the general population, estimates of incidence rates range from 0.07% [4] to as high as 0.6% [5] and 0.7%.[6,7] Both males and females can develop pectus carinatum, although it is 4 to 5 times more common in males.[2]

Can Pectus Carinatum Cause Heart Problems?

The good news is that most sources agree that pectus carinatum generally does not affect heart development or basic cardiovascular function. However, one recent study suggests that around one-fifth of patients have an identified cardiac anomaly.[8] The most common cardiac symptom seen in patients with pectus carinatum is tachycardia, or a fast heart rate.

Tachycardia can rarely occur from chest deformation, which compresses the heart and thus affects it directly.[9] However, most cases of tachycardia are caused indirectly, via its impact on lung function. Up to 22% of pectus carinatum sufferers experience asthma-like symptoms [10], and even more experience shortness of breath. The reduced lung function is usually compensated for by a faster heart rate.

What Cardiac Conditions Are Associated With Pectus Carinatum?

Chest pain occurs in around 15-20% of children suffering from pectus carinatum or pectus excavatum.[7,11] This may be related to the chest compression resulting from breastbone cartilage overgrowth.

Rarely, patients may experience more severe cardiovascular problems, such as valve malfunction or partial obstructions [12]. These appear to arise from the physical deformity of the chest.[12]

Some patients with pectus carinatum may also show mitral valve prolapse,[13] where the two flaps of the mitral valve in the heart don’t close evenly, allowing backflow of blood through the heart. Although statistics for this condition are not commonly reported, one study documented an incidence rate of 3% in pectus carinatum patients treated at a hospital.[8]

In many cases, heart conditions may be due to associated congenital heart disease rather than being caused by pectus carinatum directly.[13] Regardless, recent research suggests that all patients with pectus carinatum should be screened for cardiac abnormalities using echocardiography or a similar method.[8,14] This allows any potential abnormalities to be picked up and treated before they become more serious.

Other Impacts of Pectus Carinatum

In addition to the mild potential impacts on heart function mentioned above, it is important to note that pectus carinatum can also cause a range of other potential problems, such as: 

• Excessive or continual fatigue
• Shortness of breath
• Poor posture, particularly hunched or hooked shoulders
• Sideways or front-to-back curvature of the spine (scoliosis or kyphosis)
• Low self-esteem or poor body self-image

Consequently, although your child’s pectus carinatum should not seriously impact their heart function or health, it is important not to ignore this condition, as it will not improve on its own. Furthermore, most treatments show better outcomes if commenced as early as possible.

How Dakota Brace Can Help Your Child

The good news is that most cases of pectus carinatum can be successfully treated without requiring invasive chest surgery. Orthotic chest bracing is now recommended as the first-line treatment for all but the most severe cases of pectus carinatum.[15] Dakota Brace is a leader in this space, providing a range of orthotic braces, including the Custom Pectus Brace, Custom Rib Flare Brace, and Custom Pectus & Rib Flare Brace.

The Custom Pectus Brace best suits patients with only pectus carinatum, while those with associated rib flare will benefit from the combination brace. 

The principle behind orthotic bracing is simple: the brace applies pressure to the protruding chest region, conforming it to the desired shape. When it is worn over an extended time (usually 20–22 hours per day for around 6–12 months for the initial correction period), the brace remodels the breastbone cartilage and trains it to grow into this shape. As the cartilage hardens throughout puberty, it becomes fixed in the correct position. In general, results of orthotic bracing are overwhelmingly positive, with less than 10% of patients failing to respond to bracing treatment.

Conclusion

Does your child suffer from pectus carinatum? Here at Dakota Brace, we aim to provide the best possible treatment for pectus carinatum. With high-quality products and rapid turnaround times at an affordable cost, there is no reason to delay any longer! Arrange a free consultation with one of our health professionals and receive $75 off your first order!

References

1. Shamberger, R. C. (1996). Congenital chest wall deformities. Current Problems in Surgery, 33(6), 469-542.
2. Cobben, J. M., Oostra, R. J., & van Dijk, F. S. (2014). Pectus excavatum and carinatum. European Journal of Medical Genetics, 57(8), 414-417.
3. Shamberger, R. C., & Welch, K. J. (1987). Surgical correction of pectus carinatum. Journal of Pediatric Surgery, 22(1), 48-53.
4. Robicsek F, Watts LT. Pectus carinatum. Thorac Surg Clin. 2010;20:563–74.
5. Coskun, Z. K., Turgut, H. B., Demirsoy, S., & Cansu, A. (2010). The prevalence and effects of pectus excavatum and pectus carinatum on the respiratory function in children between 7–14 years old. The Indian Journal of Pediatrics, 77(9), 1017-1019.
6. Westphal, F. L., Lima, L. C. D., Lima Neto, J. C., Chaves, A. R., Santos Júnior, V. L. D., & Ferreira, B. L. C. (2009). Prevalência de pectus carinatum e pectus excavatum em escolares de Manaus. Jornal Brasileiro de Pneumologia, 35, 221-226.
7. Katrancioglu, O. (2023). Incidence of chest wall deformity in 15,862 students in the province of Sivas, Türkiye. Turkish Journal of Thoracic and Cardiovascular Surgery, 31(1).
8. Port, E., Hunter, C. J., Buonpane, C., Vacek, J., Sands, L., Kujawa, S., & Reynolds, M. (2020). Echocardiography reveals heart abnormalities in pediatric pectus carinatum. Journal of Surgical Research, 256, 364-367.
9. Cohee, A. S., Lin, J. R., Frantz, F. W., & Kelly Jr, R. E. (2013). Staged management of pectus carinatum. Journal of Pediatric Surgery, 48(2), 315-320.
10. Fonkalsrud, E. W. (2008). Surgical correction of pectus carinatum: lessons learned from 260 patients. Journal of Pediatric Surgery, 43(7), 1235-1243.
11. Alaca, N., & Yüksel, M. (2021). Comparison of physical functions and psychosocial conditions between adolescents with pectus excavatum, pectus carinatum and healthy controls. Pediatric Surgery International, 37, 765-775.
12. Iakovlev, V. M., Nechaeva, G. I., & Viktorova, I. A. (1990). Clinical function of the myocardium and cardio-and hemodynamics in patients with pectus carinatum deformity. Terapevticheskii Arkhiv, 62(4), 69-72.
13. Croitoru, D., & Nuss, D. (2004). Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med, 15, 455-471.
14. Haleem, A., Hanif, M. S., Majeed, F. A., Wyne, A., & Rahim, K. (2015). Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment. Pakistan Armed Forces Medical Journal, 65(2), 170-174.
15. Emil, S. (2018). Current options for the treatment of pectus carinatum: When to brace and when to operate?. European Journal of Pediatric Surgery, 28(04), 347-354.