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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
The difference between ventricular septal defect and atrial septal defect
The difference between a ventricular septal defect and an atrial septal defect mainly lies in their locations. A normal heart is divided into four chambers, which are the left ventricle, right ventricle, left atrium, and right atrium. Each chamber is separated by a septum, much like walls between rooms in a house. Due to certain reasons, such as congenital heart defects, there may be openings or defects in these walls, known as septal defects. An atrial septal defect refers to a defect between the right atrium and the left atrium, whereas a ventricular septal defect pertains to a defect between the left and right ventricles. The murmur of atrial septal defects is relatively softer, as the pressure difference between the atria is smaller, and the defect is located higher up. In contrast, the murmur of ventricular septal defects is louder due to the greater pressure difference between the ventricles and is located lower down, approximately between the third and fourth ribs. The murmur of atrial septal defects is found between the second and third ribs. Moreover, since the pressure difference in ventricular septal defects is greater, the impact on the heart is relatively more significant.
What are the symptoms of ventricular septal defect?
What are the symptoms of a ventricular septal defect? In normal individuals, there are no defects between the ventricular septa. However, if there is a small ventricular septal defect, such as less than five millimeters, typically ranging between two to three millimeters, this minor defect functions like small gaps between normal windows and doors, causing minimal shunting which generally does not significantly impact the patient, resulting in no obvious symptoms. However, if the defect is relatively large, such as exceeding five millimeters, causing significant left ventricular blood to shunt to the right ventricle, it can lead to congestion in the right ventricular system or pulmonary circulation. Under such conditions, patients may frequently experience respiratory infections, congestive heart failure, or in children, reluctance to eat, presenting feeding difficulties and developmental delays. Of course, if the defect continues to enlarge, achieving a size larger than the patient's aorta, the patient may show signs of significant right heart failure due to the damaged ventricular septum, necessitating emergency surgical intervention.
The differences between funnel chest and pigeon chest
Pectus excavatum and pectus carinatum are both types of chest wall deformities. Pectus excavatum is the most common form of chest wall deformity, accounting for over 90% of all anterior chest wall deformities, whereas pectus carinatum occurs much less frequently, roughly one-fifth the incidence of pectus excavatum. The main and most apparent difference is that, as the name suggests, pectus excavatum looks as if a funnel were placed in the chest, with the funnel pointing downwards and backwards. Thus, in patients or children with pectus excavatum, the sternum is indented inward and backward, pressing directly towards the spine. This indentation can compress the heart and lungs, potentially distorting and even displacing the heart to one side. In contrast, pectus carinatum involves the sternum protruding outward, resembling the chest of a chicken or a pigeon. Pectus excavatum is characterized by a backward indentation, while pectus carinatum protrudes forward—this is the most direct distinction.
Is pectus excavatum scary?
Is pectus excavatum scary? In a normal person, the thoracic transverse diameter and anteroposterior diameter have a normal ratio. For example, in normal individuals, this ratio of the transverse diameter to the anteroposterior diameter is less than 2.5. However, some children, due to congenital or acquired reasons, may have a sternum that is concave inward in the middle. In such cases, the concavity of the sternum significantly reduces the anteroposterior diameter, and the ratio of the transverse to anteroposterior diameter then becomes greater than 2.5. For pectus excavatum where the ratio is between 2.5 and 3.5, we suggest conservative treatment or observation, and a pectus excavatum suction cup can be used. If the ratio is greater than 3.5, the pectus excavatum is very pronounced, and we recommend surgical treatment. In severe cases of pectus excavatum, where the ratio of the transverse to anteroposterior diameter is greater than 4, there are instances where the chest is almost touching the back, with only a few millimeters of space between the anterior chest wall and the spine during surgery. In such severe cases, the heart is completely pushed to the left side of the patient, significantly affecting both cardiac and pulmonary function, impacting the patient’s physical development. In severe cases, it can also cause significant psychological issues, including severe feelings of inferiority, lack of self-confidence, poor social skills, and even severe depression or suicidal tendencies. Therefore, severe pectus excavatum can indeed be quite frightening.
How to exercise the pectoral muscles with pectus excavatum?
How to exercise the pectoral muscles with pectus excavatum, we know that the indentation of pectus excavatum is concave inward and backward, that is, the front sternum in the middle of a person's chest compresses backward towards the spine. Exercising the pectoralis major muscle aims to lift the muscles on both sides of the sternum, but the attachment point of the pectoralis major actually pulls from the ribs outward and upward towards the humeral tuberosity of the arms. This type of lifting actually pulls the force of the ribs or a part of the sternum outward, and it cannot pull forward. Indeed, the forward force is the direction truly needed when correcting pectus excavatum. Therefore, patients with pectus excavatum can exercise the pectoralis major, do push-ups, and perform dumbbell fly exercises, which are all feasible. However, such exercise will only make the pectoral muscles thicker and the force is directed sideways, and it cannot effectively pull the downward and inward-concaved sternum forward. Therefore, although individuals with pectus excavatum can perform exercises like push-ups and dumbbell flies like normal individuals, these exercises should not be expected to significantly improve pectus excavatum. Moreover, current medical technology and trials have not found exercising the pectoralis major to have a substantial corrective effect on pectus excavatum.
What should be noted in daily life for people with funnel chest?
Since pectus excavatum is an inward and backward depression, such a depression may gradually become apparent even from a young age, especially worsening during adolescence. Therefore, children or patients with this condition should be aware of any significant lack of calcium or vitamin D. Of course, since pectus excavatum may also be somewhat related to familial genetic factors, it is important to check whether the child has any congenital heart diseases, Noonan syndrome, or connective tissue disorders. Since pectus excavatum causes an inward and backward indentation that compresses the heart and lungs, children with this condition may not be able to fully expand their lungs or completely relax their hearts. Consequently, these children tend to have a weaker constitution and may catch colds easily. Therefore, children with pectus excavatum should avoid crowded places, as their weaker constitution makes them more susceptible to colds, which can exacerbate their developmental issues, thus creating a vicious cycle.
Complications of rib fractures
Rib fracture complications. Structurally, each rib is located above the intercostal arteries, veins, and nerves. Therefore, the most critical issue with rib fractures is that they can cause severe pain for the patient. Thus, the main complication of a rib fracture is pain. This pain persists 24 hours a day, especially when the patient takes deep breaths, coughs, or turns over while sleeping during the night, which can awaken them due to the severe pain. Additionally, because of this pain, the patient is unable to cough effectively. Therefore, a large amount of phlegm, especially in smokers, accumulates in the lungs, leading to complications such as lung infections and pneumonia. Besides pain, another complication of rib fractures is the potential puncture of intercostal arteries or veins, which can cause hemothorax. This condition can result in a significant accumulation of blood in the pleural cavity, and a severe hemothorax can be life-threatening, especially a progressing hemothorax. Therefore, for patients with fractures of three or more ribs, it is recommended, according to the 2017 US guidelines for the treatment of internal fractures and the 2018 consensus from Chinese experts on internal fracture treatment, to actively proceed with surgical interventions. Studies have found that active surgical intervention for fractures of more than three ribs can significantly reduce the patient's pain, shorten hospital stays, and improve quality of life. In summary, the main complications of rib fractures include pneumothorax, hemothorax, pain, and resultant lung infections and pneumonia. These complications are crucial in the treatment of rib fractures and need to be actively addressed.
Can people with funnel chest work?
Whether pectus excavatum can affect work depends on two aspects. Firstly, if it is a mild case of pectus excavatum, with an index less than 3.25, such mild conditions do not cause significant compression on the heart or lungs, and the patient will not have too many work-related issues. However, if the pectus excavatum index is greater than 3.25 and the chest is sunken inward and backward, significantly compressing the heart and lungs, such a condition prevents the heart from fully relaxing and the lungs from fully expanding, which can impact the patient's activities. Besides the physiological impact, this condition can also significantly affect social interactions, especially for young children or adults. Some patients may suffer severe inferiority complexes, depression, and even suicidal tendencies, which, of course, will also affect their work capability and state. Therefore, for severe cases of pectus excavatum, it is recommended to wait until after treatment to return to work. Once the pectus excavatum is corrected, and the heart and lung functions are no longer compressed, and the appearance is normalized, the patient's work capability should be completely fine.
Harm of funnel chest suction cup
Recently, the use of vacuum bells for pectus excavatum has become very common in China, and their promotion has been very aggressive. However, for children using these devices, it's important to be cautious since they have pectus excavatum, a congenital deformity where the sternum is sunken inward and backward. One must ensure these patients do not have congenital heart diseases. If the patient also suffers from congenital heart defects like atrial septal defect, ventricular septal defect, or patent ductus arteriosus, using the vacuum bell to forcefully pull out the sunken sternum might lead to deformation of the heart and worsen the septal defects. Therefore, before using the vacuum bell, it is essential to rule out the possibility of congenital heart diseases in patients, which can be done through an echocardiogram. Secondly, using the vacuum bell with excessive force might cause bruising and capillary bleeding in the patient’s skin.
Can funnel chest be cured?
In fact, many diseases cannot be completely cured, including the common cold, for which there is currently no way to completely eradicate it, meaning there isn't a medicine that, once taken, prevents one from ever catching a cold again. Of course, this has a lot to do with the mutations of the cold virus. However, pectus excavatum can be cured, and there are generally two methods of treatment for it: surgical and non-surgical. The surgical method is suitable for older patients with harder bones. Conservative treatment is appropriate for younger patients with more elastic rib cages, who can cooperate well, or whose family can supervise and support them through this non-surgical approach. Regardless, it is completely possible to cure pectus excavatum, and there are methods to do so.