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Zhang Zhi Gong
Cardiothoracic Surgery
About me
Zhang Zhigong, male, associate chief physician, with a postgraduate degree. He is the vice chairman of the Youth Academic Committee of Hunan Provincial People's Hospital and the secretary of the Thoracic Surgery Department. He has been engaged in thoracic surgery for over ten years and has visited Shanghai Pulmonary Hospital, Chest Hospital, and Henan Zhengzhou First Hospital for learning. In 2015, he was selected by the hospital to study abroad at the teaching hospital of University of Göttingen, Germany.
Proficient in diseases
Proficient in minimally invasive single-port thoracoscopy, lung bullae, pneumothorax, advanced lung cancer, thermal ablation, radioactive seed implantation, minimally invasive NUSS funnel chest surgery, and other minimally invasive surgeries. Also, was the first in the world to apply 3D printing to the treatment of rib fractures in cardiothoracic surgery. Has extensive clinical experience in congenital and acquired heart diseases.
Voices
Funnel chest surgery principle
The Wang procedure, named after Director Wang Wenlin from the Second People's Hospital of Guangdong Province, is a surgical method for correcting pectus excavatum. Traditional minimally invasive techniques for correcting pectus excavatum, such as the Nuss procedure or its modifications, involve placing a metal bar under or behind the sternum, forming an arch to lift the depressed area, similar to a traditional arch bridge. In contrast, the Wang procedure positions the metal bar on top and in front of the sunken sternum, and then uses stainless steel wires to suspend the deformed sternum forward and upward, transforming the traditional arch into a modern cable-stayed bridge, thus suspending the depressed chest area.
Minimally invasive surgery for pectus excavatum
Minimally invasive surgery for pectus excavatum has evolved over the decades, with various surgical methods developing since the most classical NUSS procedure introduced by Donald Nuss in the 1990s. His basic surgical process involves administering general anesthesia to the patient, who is then laid flat on the operating table. A horizontal line is drawn from the deepest part of the depression to the armpit, where one to two small incisions are made under the armpit. The skin is then freed to access the chest cavity, and a steel plate is gradually inserted behind the sternum at its deepest point, after which the depressed sternum is elevated by flipping the plate. Of course, there have been improvements to the NUSS procedure, such as the modified Nuss procedure that reduces the flipping process, thus minimizing the impact and damage to the bones. For instance, ultra-minimally invasive surgeries, which require only a single-port incision, have evolved from the NUSS procedure by reducing or eliminating the need for flipping or an incision. Later, the Wang procedure involved placing the steel plate in front of the sternum, using the principle of a suspension bridge to elevate the depressed sternum. Thus, the evolution of surgery for pectus excavatum continues to advance, with the surgical processes improving, wounds becoming smaller, and the number of incisions decreasing.
Can moderate pigeon chest in children be corrected?
Can mild pectus carinatum in children be corrected? Pectus carinatum, commonly known as pigeon chest, is the second most common chest deformity encountered, after funnel chest. As the name suggests, pigeon chest refers to a protrusion of the sternum in the center, similar to the chest of a chicken or pigeon, where the sternum protrudes forward. This protrusion, to draw an analogy, is like a tree. This young sapling has already grown crooked. You cannot straighten it by fertilizing or any other means. Correction is only possible through procedures such as orthotic braces or compression, or more directly and effectively through surgical intervention. Surgery is the most straightforward and immediately impactful treatment method.
Symptoms of ventricular septal defect
The main symptoms of a ventricular septal defect depend on the size of the defect and the age of the patient. Generally, smaller ventricular septal defects, such as those measuring only one to two millimeters, result in very little shunting from the left ventricular system to the right ventricular system. This is akin to a tiny amount of air seeping through a crack in a window or door. In such cases, the patient typically does not exhibit noticeable symptoms. However, if the defect is larger, over five millimeters, a significant amount of blood passes from the left ventricular system into the right ventricular system, which can cause substantial congestion in the right or both lungs of the right ventricular system, or lead to recurrent respiratory infections and congestive heart failure. The affected individual may show disinterest in eating, feeding difficulties, and delayed development. As the patient grows older, they may exhibit reduced activity endurance, fatigue or palpitations, and shortness of breath. Gradually, cyanosis and right heart failure may develop. Additionally, patients are at risk of developing infective endocarditis, fever without symptoms, and recurring fever.
Pectus excavatum heart hazards
Pectus excavatum can harm the patient's or child's heart, primarily manifesting in compression of the heart and affecting the function of the internal heart valves. Imagine a normal person's rib cage, which is oval in cross-section. There is a certain ratio between the lateral diameter and the anterior-posterior diameter, with normal individuals having a ratio of less than 2.5. However, in patients with pectus excavatum, this anterior-posterior diameter is significantly compressed, meaning the sternum moves closer to the spine, compressing inward and backward, squeezing the heart - this is the first step. The heart itself is a contractile muscular organ, its purpose being to eject blood and circulate it throughout the body. If the sternum and spine directly compress the heart, preventing it from fully expanding, then blood cannot fully flow back into the heart, and thus the ejection or pumping function of the heart will be impacted. Secondly, besides the heart being compressed, just like a house becoming deformed from being squeezed, the doors within the house cannot function properly; they cannot close or open well. Thus, pectus excavatum not only compresses the heart itself but also severely harms the function of the heart valves, even causing mitral valve prolapse in some patients.
Can people with funnel chest gain weight?
The majority of pectus excavatum cases encountered clinically are congenital thoracic deformities, which means the sternum in the middle of the chest is indented inward and backward. This inward and backward indentation can compress the lungs and the heart, especially in severe cases of pectus excavatum, causing significant compression to the lungs and heart. It prevents the heart from fully expanding, and might even push the entire heart into the left chest cavity, also preventing the lungs from effectively expanding. Therefore, children with this condition tend to have weaker constitutions, are prone to colds, and their ability to engage in physical activities like running is not as good as other children. Pectus excavatum generally affects the development of children, especially in severe cases. Mild pectus excavatum involves only a slight indentation and does not severely compress the heart, and children with such a condition can still gain weight if their nutrition is adequate. However, in severe cases of pectus excavatum, besides impacting the heart and lungs, it can also affect the patient's personality, self-confidence, and social interactions, potentially leading to insecurity, depression, and even suicidal tendencies.
Harm of pectus excavatum
The dangers of pectus excavatum can generally be divided into two aspects: one is the harm to the physiological functions of the patient, and the other is the psychological impact on the patient. The physiological harm can be further divided into two categories: one is the impact on lung function, and the other is the impact on heart function. We can imagine that in normal individuals, the sternum is positioned in front of the heart and lungs. However, in patients with pectus excavatum, due to congenital hereditary or genetic factors, the sternum is pushed backward towards the spine, compressing inward and backward, which causes the heart to be squeezed, deformed, and the lungs to be compressed, preventing them from fully expanding. Thus, both the heart and lungs of the patient are subjected to certain pressures, affecting both cardiac and pulmonary functions. In addition to the impact on cardiopulmonary function, the patient's thoracic cage is deformed. It appears as if the center of the chest has been punched in. This kind of deformed chest affects the patient's social abilities, including interactions with potential boyfriends or girlfriends. Imagine, for instance, removing one's shirt at the pool in summer, attracting stares as if one were a monster. Therefore, patients may lack confidence, especially in romantic and social interactions, and some may even experience certain levels of depression or suicidal tendencies.
Ventricular septal defect refers to a defect in the ventricular septum, the wall dividing the left and right ventricles of the heart.
A normal human heart is divided into four chambers: the left ventricle, right ventricle, left atrium, and right atrium. The circulation in a normal person involves venous blood entering the right atrium, passing through the mitral valve into the right ventricle. The right ventricle then contracts and pumps blood into the lungs. After exchanging gases and becoming oxygenated, the blood turns bright red. It then returns to the left atrium. From the left atrium, blood passes through the mitral valve back into the left ventricle, and then the left ventricle contracts and pumps blood throughout the body. Therefore, there is a thick wall between the normal left and right ventricles, known as the ventricular septum. If due to congenital heart disease or other reasons, a small hole appears in the ventricular septum, it is called a ventricular septal defect. If this defect is large, it necessitates active surgical treatment because if the defect exists, the pressure of the blood flow in the left ventricle is higher, causing a large amount of abnormal blood to enter the right ventricle. This leads to a significant accumulation of blood in the right ventricle, causing the patient to have too much blood in the pulmonary circulation, making the patient prone to recurrent colds and infections. Furthermore, these children may easily develop heart failure and even life-threatening conditions such as infective endocarditis.
Pectus excavatum is caused by what?
The specific etiology of pectus excavatum is not completely clear, but there are mainly two types of pectus excavatum: the simple type and the complex type, which means it is accompanied by other diseases. Currently, pectus excavatum is somewhat related to congenital genetic inheritance. This is because pectus excavatum is related to many connective tissue disorders, and many patients with congenital diaphragmatic hernias, psychogenic subglottic stenosis, and underdeveloped bronchopulmonary tissues also present with pectus excavatum. Although these diseases do not directly cause pectus excavatum, the reasons for the development of pectus excavatum, whether directly related to connective tissue disorders or not, are somewhat related to genetic factors. Therefore, it is currently considered that pectus excavatum is caused by genetic factors and inheritance.
How to treat pectus excavatum?
There are many treatment methods for pectus excavatum, and the choice depends on the severity of the pectus excavatum, the age and chest wall elasticity of the child with pectus excavatum, the potential for further growth and development, and the expectations of the patient and their family. For younger children with pectus excavatum, where the chest wall is more elastic and soft, and in cases of mild pectus excavatum, a pectus excavatum suction cup can be considered. This device uses a certain amount of pressure, similar to a car suction cup, which is commonly seen in auto repair shops where a dented plastic bumper is gradually pulled out using a suction cup. This principle is also utilized by the pectus excavatum suction cup. Of course, this is under the premise that the patient is younger and has a softer chest, making it easier to be corrected by suction. For older patients with a harder chest, using a suction cup might not be appropriate, and surgical treatment may need to be considered. There are several surgical techniques available, ranging from the early Ravitch procedure, which involves a sternotomy and complete detachment of the sternum followed by flipping it, to the later Nuss procedure, and up to the current Wang surgical method and minimally invasive techniques.