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The ABC of Pectus Excavatum: a novel anatomical classification system


Pectus Excavatum affects between 1:400 - 1000 live births. Little academic focus has been directed to the anatomical subgroups of this condition. No anatomical classification and subgrouping has been formulated. Current surgical strategies utilize a 'one size fits all' philosophy with variations of the Nuss or Ravitch procedure


Our aim was to stratify patients with Pectus Excavatum by providing an anatomical classification that would guide treatment. The novel classification we propose provides a framework for use with current and evolving medical technologies


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


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.


Our classification provides a framework for evaluation of the pathological anatomy of Pectus Excavatum. This classification has been shown to have utilitarian value in planning surgical strategy. The model will provide opportunities for future development of surgical technique and provides a descriptor that will allow academic discussion

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Mazhar, K., Cliff, I., Watson, N. et al. The ABC of Pectus Excavatum: a novel anatomical classification system. J Cardiothorac Surg 10 (Suppl 1), A277 (2015).

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