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Canadian Medical First: 17-year-old patient becomes first in Canada to undergo minimally invasive pectus carinatum repair

20 August 2014

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For Immediate Release

Montreal, Wednesday, August 20, 2014 – 17 year-old Mackenzie developed a condition called pectus carinatum (his chest wall was pushed outward) which caused him self-esteem issues as well as exercise intolerance reducing his participation in his favorite sports. On July 10^th, 2014, he was the first patient in Canada to undergo a ground-breaking minimally invasive pectus carinatum repair, called a reverse Nuss procedure. Most patients who have pectus carinatum undergo successful bracing to correct the anomaly. Those who are not good candidates for bracing now have a new option which will allow them to have more immediate results. This surgical treatment is the newest of the innovative treatment options developed by the joint team bringing together experts from Shriners Hospitals for Children^®-Canada and the Montreal Children’s Hospital for teens who develop chest wall anomalies.

The Surgery

Roughly 1 out of 1,500 children are affected by pectus carinatum. Historically, patients underwent a very invasive and painful surgery which involved separating the sternum from the ribs. Three years ago, the joint teams introduced innovative bracing which corrected most of the deformities although a subset of patients did not respond to the treatment or were not good candidates for it. “For patients with pectus carinatum, we have introduced the most successful bracing technique, many patients have avoided surgery altogether” says Sherif Emil, M.D., CM, Director, Division of Pediatric General and Thoracic Surgery, Montreal Children’s Hospital and co-director of the Chest Wall Anomalies Clinic at Canada Shriners Hospital. He adds “for some patients, who still need the surgery, we introduced for the first time in Canada, the reverse Nuss procedure, where a bar is installed that pushes down on the sternum, then is bolted to the ribs on each side”. This new technique was brought to us by Robert E. Kelly Jr., M.D., Chief, Division of Pediatric Surgery and Chief, Department of Surgery, Children’s Hospital of the King’s Daughters in Norfolk, Virginia. For patients like Mackenzie, the deformity is corrected almost immediately, and then within 2-3 years the bar is removed. Mackenzie is “extremely satisfied with the results” and just over a month after the surgery he has returned to his normal everyday routine and looks forward to beginning CEGEP (college) in the fall.

The First Clinic in Canada

The first of its kind in Canada, the Chest Wall Anomalies Clinic is celebrating its third year. It evaluates and treats children with congenital chest wall deformities. The multidisciplinary clinical team is composed of pediatric general surgeons, orthopaedic surgeons, pulmonologists, pediatricians, nurses, physiotherapists, medical imaging specialists, and orthotists, with additional services as needed offered by plastic surgeons, cardiologists, and geneticists from both Shriners Hospitals for Children–Canada and Montreal Children’s Hospital. The team provides state-of-the-art care for the entire range of chest wall anomalies in a family-centered environment focused on the medical and self-esteem issues that are typical with these conditions.

Different Types of Chest Wall Anomalies

The two most common types of the disorder, pectus excavatum (a caved-in sternum or funnel chest) and pectus carinatum (a protrusion of the chest wall or pigeon chest) result when the ribs and sternum develop in an unusual manner. Mild deformities often are not discovered by physicians unless children are referred for coincidental scoliosis. If not treated adequately, patients may experience shortness of breath, low endurance and frequent respiratory difficulties, which can have a significant impact on an infant’s ability to grow and to develop normally.

Refer a patient to the Chest Wall Anomalies Clinic

To refer a child to the Chest Wall Anomalies Clinic, pediatricians, physicians and families across Canada can contact Shriners Hospitals for Children – Canada at 1-800-361-7256 ext.6971.

About Shriners Hospitals for Children- Canada

Shriners Hospitals for Children is changing lives every day through innovative pediatric specialty care, world-class research and outstanding medical education. Located in Montreal, Shriners Hospitals for Children – Canada is a bilingual, short term, acute care centre providing elective pediatric orthopaedic health care. The role of the hospital is to promote health and to provide treatment and rehabilitation to children with orthopaedic and neuromuscular problems from across Canada and the North East US. The hospital is committed to excellence and innovation in clinical practice, research and education and to providing a caring environment to families. To learn more about Canada’s Shriners Hospital, please visit http://www.exceptionalcare4kids.com.

About the Montreal Children’s Hospital

The Montreal Children’s Hospital (MCH) is the pediatric teaching hospital of the McGill University Health Centre and is affiliated with McGillUniversity. The MCH is a leader in providing a broad spectrum of highly specialized care to newborns, children, and adolescents from across Quebec. Our areas of medical expertise include programs in brain development/behaviour, cardiovascular sciences, critical care, medical genetics and oncology, tertiary medical and surgical services, and trauma care. Fully bilingual, the hospital also promotes multiculturalism and serves an increasingly diverse community in more than 50 languages. The Montreal Children’s Hospital sets itself apart with its team approach to innovative patient care. Our health professionals and staff are dedicated to ensuring children and their families receive exceptional health care in a friendly and supportive environment.

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Gemma Bélanger