PECTUS EXCAVATUM, PECTUS CARINATUM SUR716.005 ______COVERAGE:

In most cases of pectus excavatum or pectus carinatum there are no significant functional limitations due to the deformity. Children may develop a poor self image and become withdrawn or shy. In these cases the primary indication for operation is cosmetic; therefore, it is not covered by the benefit plan.

Surgical correction is generally restricted to patients who have severe deformity accompanied by evidence of lung restriction or cardiovascular dysfunction. Patients with evidence of respiratory insuffiency, particularly during exercise, are appropriate candidates for surgery. Even a deep funnel chest is not necessarily an indication for surgery, if the patient has no complaints and can manage the situation. The best surgical results are obtained at the age of 2 to 3 years. Whenever it is possible, the correction should be done before the age of 5 years. Although the severity of the pectus deformity may be assessed by determining the ratio of the transverse diameter of the chest to the anteroposterior diameter as measured by computerized tomography (CT), it is not clear whether this index predicts improvement in lung function with surgery.

The following diagnostic studies may be performed preoperatively as well as postoperatively:

· pulmonary function studies, · electrocardiogram (EKG) or stress EKG, · echocardiogram, · angiocardiograms (not routinely indicated but may be needed to confirm compression of the right ventricle) and/or · computerized tomography.

NOTE: Diagnostic studies to assess chest pain in adults with moderate to severe forms of pectus excavatum may be complicated by the associated displacement of the heart in the chest cavity. ______DESCRIPTION:

Pectus Excavatum ("funnel chest") is the most common of the major congenital deformities of the sternum. This boney and cartilaginous malformation can vary from a very mild and scarcely noticeable deformity to one that is quite severe and symptomatic. The primary problem is a deformity of the costal cartilages, which have developed in a concave position and depress the sternum toward the vertebral column. The heart is often displaced to the left. Most of the defects are apparent at birth, but occasionally may not become noticeable until weeks or months later. In general, the defect increases with time. Studies have provided evidence that both cardiac and respiratory function tend to be somewhat lower than normal.

Pectus Carinatum ("pigeon breast"), although less common than pectus excavatum, is not an infrequent malformation. It consists of protrusion of the sternum caused by an upward curve in the lower costal cartilages (generally the fourth to the eighth cartilages), pushing the sternum forward. This defect is usually obvious. Symptoms may occur and include exertional dyspnea and cardiac arrhythmias. It may be difficult for the chest to expand during inspiration. ______RATIONALE:

None ______DISCLAIMER:

State and federal law, as well as contract language, including definitions and specific inclusions/exclusions, takes precedence over Medical Policy and must be considered first in determining coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Any benefits are subject to the payment of premiums for the date on which services are rendered. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically. HMO Blue Texas physicians who are contracted/affiliated with a capitated IPA/medical group must contact the IPA/medical group for information regarding HMO claims/reimbursement information and other general polices and procedures. ______Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company* Southwest Texas HMO, Inc.* d/b/a HMO BlueÒ Texas * Independent Licensees of the Blue Cross and Blue Shield Association ______Posted Jan. 7, 2003