The ABC of Pectus Excavatum: a novel anatomical classification system

Method Between April 2006 March 2015, 24 patients (22 male : 2 female; Age 15 33 years) presented to our institute with symptomatic Pectus Excavatum. All presented with symptoms of dyspnoea /fatigue/dysphagia. All patients underwent Prospective evaluation of exercise and anatomical characteristics by: Spirometry; Cardiopulmonary exercise tolerance (CPEX) testing & Non-contrast axial/ sagittal CT scan of the thorax & 3D reconstruction. We propose an Anatomical classification based on 2D and 3D CT imaging:Classification A : No depression of manubrium, posterior angulation of sternal bodyClassification B: (1) Horizontal depression of manubrium and sternal body with no angulation (2) Depression of manubrium with posterior angulation of sternal bodyClassification C: Complex asymmetrical torsion of manubrium and body of sternum associated with asymmetrical distortion and depression of rib cage Results 9 patients (38%) had a Type A defect. We recommend this sternal body angulation to be corrected with Ravitch Procedure, Transverse osteotomy and midline screw fixation bar. 14 (58%) patients had a Type B2 defect, which we recommend should be repaired as a Type A defect but elevation of the whole sternum using a transverse screw fixation bar.