Association between pectus excavatum and congenital genetic disorders: A systematic review and practical guide for the treating physician

Ryan J. Billar, Wiem Manoubi, Sarina G. Kant, René M.H. Wijnen, Serwet Demirdas, Johannes M. Schnater*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

2 Citations (Scopus)
10 Downloads (Pure)


Background: Pectus excavatum (PE) could be part of a genetic disorder, which then has implications regarding comorbidity, the surgical correction of PE, and reproductive choices. However, referral of a patient presenting with PE for genetic analysis is often delayed because additional crucial clinical signs may be subtle or even missed in syndromic patients. We reviewed the literature to inventory known genetic disorders associated with PE and create a standardized protocol for clinical evaluation. Methods: A systematic literature search was performed in electronic databases. Genetic disorders were considered associated with PE if studies reported at least five cases with PE. Characteristics of each genetic disorder were extracted from the literature and the OMIM database in order to create a practical guide for the clinician. Results: After removal of duplicates from the initial search, 1632 citations remained. Eventually, we included 119 full text articles, representing 20 different genetic disorders. Relevant characteristics and important clinical signs of each genetic disorder were summarized providing a standardized protocol in the form of a scoring list. The most important clinical sign was a positive family history for PE and/or congenital heart defect. Conclusions: Twenty unique genetic disorders have been found associated with PE. We have created a scoring list for the clinician that systematically evaluates crucial clinical signs, thereby facilitating decision making for referral to a clinical geneticist.

Original languageEnglish
Pages (from-to)2239-2252
Number of pages14
JournalJournal of Pediatric Surgery
Issue number12
Early online date24 Apr 2021
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
We kindly thank Wichor Bramer, biomedical information specialist, Erasmus University Medical Center, Rotterdam, the Netherlands; for his expertise with the literature search. Ko Hagoort, MA, Erasmus University Medical Center, Rotterdam, the Netherlands, is thanked for providing editorial advice.

Publisher Copyright:
© 2021


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