{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:53:22Z","timestamp":1787320402897,"version":"build-2736575974"},"reference-count":88,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:title>EXECUTIVE SUMMARY<\/jats:title>\n                  <jats:p>Pectus defects are a group of congenital conditions found in approximately 1 in 250 people, where the sternum is depressed back towards the spine (excavatum), protrudes forwards (carinatum) or more rarely is a mixture of both (arcuatum or mixed defects). For the majority of patients, it is well tolerated, but some patients are affected psychologically, physiologically or both.<\/jats:p>\n                  <jats:p>The deformity becomes apparent at a young age due to the growth of the ribs and the cartilage that links them to the sternum. The majority of defects are mild and are well tolerated, i.e. they do not affect activity and do not cause psychological harm. However, some young people develop lower self-esteem and depression, causing them to withdraw from activities (such as swimming, dancing) and from interactions that might \u2018expose\u2019 them (such as sleepovers, dating, going to the beach and wearing fashionable clothes). This psychological harm occurs at a crucial time during their physical and social development. A small number of patients have more extreme depression of their sternum that impedes their physiological reserve, which can occur when engaging in strenuous exercise (such as running) but can also limit moderate activity such as walking and climbing stairs. The effects can be so extreme that symptoms occur at rest or cause life-threatening compression of the major blood vessels and organs. The group of patients with physiological impairment usually also suffer from low self-esteem and depression.<\/jats:p>\n                  <jats:p>This paper summarizes the current evidence for the different treatment strategies for this condition, including supportive care, psychological support and non-surgical techniques including bracing and vacuum bell therapy. We also consider surgical techniques including the Ravitch procedure, the Nuss procedure (minimally invasive repair of pectus excavatum), pectus implants and other rare procedures such as Pectus Up.<\/jats:p>\n                  <jats:p>For the majority of patients, supportive care is sufficient, but for a minority, a combination of the other techniques may be considered.<\/jats:p>\n                  <jats:p>This paper also outlines best practice guidance for the delivery of such therapies, including standardized assessment, consent to treatment, audit, quality assurance and long-term support.<\/jats:p>\n                  <jats:p>All the interventions have risks and benefits that the patient, parents and clinicians need to carefully consider and discuss when deciding on the most appropriate course. We hope this evidence review of \u2018Best Practice for Pectus\u2019 will make a significant contribution to those considerations and help all involved, from patients to national policy makers, to deliver the best possible care.<\/jats:p>","DOI":"10.1093\/ejcts\/ezae166","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T08:51:38Z","timestamp":1714467098000},"source":"Crossref","is-referenced-by-count":20,"title":["The pectus care guidelines: best practice consensus guidelines from the joint specialist societies SCTS\/MF\/CWIG\/BOA\/BAPS for the treatment of patients with pectus abnormalities"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8792-5089","authenticated-orcid":false,"suffix":"(UK)","given":"Joel","family":"Dunning","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic surgery, James Cook University Hospital , Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Clare","family":"Burdett","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic surgery, James Cook University Hospital , Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Anne","family":"Child","sequence":"additional","affiliation":[{"name":"Marfan Trust , Bromley, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Carl","family":"Davies","sequence":"additional","affiliation":[{"name":"Royal College of Physicians and Surgeons of Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Deborah","family":"Eastwood","sequence":"additional","affiliation":[{"name":"British Orthopaedic Association, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6812-2934","authenticated-orcid":false,"suffix":"(UK)","given":"Tim","family":"Goodacre","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons of England , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8426-5011","authenticated-orcid":false,"given":"Frank-Martin","family":"Haecker","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Children\u2019s Hospital of Eastern Switzerland , St Gallen, Switzerland"},{"name":"Department of Paediatric Surgery, Faculty of Medicine, University of Basel , Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1222-6483","authenticated-orcid":false,"suffix":"(UK)","given":"Simon","family":"Kendall","sequence":"additional","affiliation":[{"name":"Society for Cardiothoracic Surgery in Great Britain and Ireland , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Shyam","family":"Kolvekar","sequence":"additional","affiliation":[{"name":"National Pectus Centre, Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(USA)","given":"Lisa","family":"MacMahon","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Phoenix Children\u2019s Hospital , Phoenix, USA"},{"name":"Chest Wall International Group (CWIG), Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Sean","family":"Marven","sequence":"additional","affiliation":[{"name":"British Association of Paediatric Surgeons Thoracic and Airway Group , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Sarah","family":"Murray","sequence":"additional","affiliation":[{"name":"Clinical Research Collaborative BHF and Leicester University, National PPI Group, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1576-230X","authenticated-orcid":false,"suffix":"(UK)","given":"Babu","family":"Naidu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Birmingham Heartlands Hospital , Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Bejal","family":"Pandya","sequence":"additional","affiliation":[{"name":"National Pectus Centre, Department of Cardiothoracic Surgery, St Bartholomew\u2019s Hospital , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"(UK)","given":"Karen","family":"Redmond","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, School of Medicine, University College Dublin, National Thoracic Subcommittee Lead SCTS, The Mater Hospital , Dublin, Dublin, Ireland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7858-3283","authenticated-orcid":false,"suffix":"(UK)","given":"Aman","family":"Coonar","sequence":"additional","affiliation":[{"name":"Thoracic Lead at NHS England, President of the Society for Cardiothoracic Surgery in Great Britain and Ireland , London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,7,4]]},"reference":[{"key":"2024070500034553300_ezae166-B1","doi-asserted-by":"crossref","first-page":"e0232575","DOI":"10.1371\/journal.pone.0232575","article-title":"Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape","volume":"15","author":"Biavati","year":"2020","journal-title":"PLoS One"},{"key":"2024070500034553300_ezae166-B2","author":"NHS England Evidence 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Sci"},{"key":"2024070500034553300_ezae166-B6","first-page":"809","article-title":"Methodology manual for European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines","volume":"48","author":"Sousa-Uva","year":"2015","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024070500034553300_ezae166-B7"},{"key":"2024070500034553300_ezae166-B8","doi-asserted-by":"crossref","first-page":"409","DOI":"10.21037\/acs.2016.08.06","article-title":"Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis","volume":"5","author":"Kanagaratnam","year":"2016","journal-title":"Ann Cardiothorac Surg"},{"key":"2024070500034553300_ezae166-B9","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ejrad.2019.06.014","article-title":"Preoperative multimodality imaging of pectus excavatum: state of the art review and call for standardization","volume":"117","author":"Rodr\u00edguez-Granillo","year":"2019","journal-title":"Eur J 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