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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
Can people with pectus excavatum join the military?
Theoretically, the current conscription system does not have strict restrictions on mild cases of pectus excavatum. However, obvious moderate or severe pectus excavatum, or sternums that are inwardly and backwardly concave, can significantly impact the function of both the heart and lungs by compressing them. This inward concavity can restrict the heart’s ability to fully expand, potentially causing complete deformation of the heart, or even prevent the heart’s valves from closing fully, leading to valve regurgitation. Such compromised cardiac and pulmonary functions are likely unable to withstand the physical demands experienced during military service. Therefore, for moderate and severe cases of pectus excavatum, we do not recommend enlisting in the military, although the current policy does not have clear restrictions on mild cases of pectus excavatum.
What should be noted for pectus excavatum in daily life?
The biggest difference between children with pectus excavatum and normal children lies in the middle chest bone structure sinking backwards and inward toward the spine, creating a deformity where the front chest and the back compress each other. Naturally, this completely compresses the normal position of the heart and lungs. Therefore, the heart of such children is compressed and deformed, pushing the entire heart to one side. We have encountered clinically cases where there are just a few millimeters of space between the sternum and the spine, leaving no room for the heart, thus completely compressing and pushing it to the left side. Imagine a heart, completely compressed and deformed, where the valves inside cannot function normally. Hence, some children may exhibit insufficiencies in their tricuspid and mitral valves. Therefore, in children with pectus excavatum, their heart is under pressure, their valves deformed, leading to poor cardiac function, and their lung function is also compromised. Since the lungs also need space to expand, lungs that are completely compressed cannot fully relax, resulting in such children having poor cardiac and lung functions, reduced exercise endurance, and since the lungs cannot fully expand, such children are prone to catching colds. Thus, for children with pectus excavatum, it is important to avoid catching colds. Moreover, treating the root cause of the condition, which is pectus excavatum itself, is crucial. Therefore, correcting pectus excavatum early on is essential.
What should be noted for pectus excavatum?
We know that behind the sternum of a normal person are the heart and lungs. Pectus excavatum is a deformity where this part of the sternum is pressed inward towards the spine. Such inward compression, as it occurs right against the bony spine, will directly squeeze the heart and in severe cases, can lead to insufficiency in the heart valve closure. Therefore, the most critical issue with pectus excavatum is the compression of the heart, which also compresses the lungs. Thus, 80% of children with pectus excavatum have lower exercise capacity compared to normal children, 60% may experience chest pain, and 40% have a significantly higher respiratory rate than normal children. Therefore, for patients with pectus excavatum, it is crucial to be cautious about common colds, as their respiratory and cardiac functions can be greatly affected if they catch a cold.
How is funnel chest formed?
Regarding the cause of pectus excavatum, there have historically been many hypotheses. For a while, medical experts believed that pectus excavatum was caused by the backward pulling of the diaphragm behind the sternum. Thus, for a time, surgeries abroad involved cutting the portion of the diaphragm behind the depressed area of the chest. Eventually, it was discovered that such cutting did not significantly benefit the treatment of pectus excavatum, and the results were not very conclusive. Therefore, this hypothesis was later debunked. To date, it is generally believed that the primary formation of pectus excavatum is somewhat related to genetic or hereditary factors. Of course, not all cases of pectus excavatum are due to parents having the condition; it might be present in the genes of ancestors and only manifest in the current generation or in this patient. Additionally, pectus excavatum could be associated with other diseases, such as connective tissue disorders. For example, some patients might have congenital diaphragmatic hernias, and after surgical repair, they could be prone to pneumothorax. Furthermore, some patients may suffer from pectus excavatum due to subglottic stenosis and underdeveloped bronchopulmonary structures, possibly triggered by respiratory factors. However, no matter the details, the formation of pectus excavatum is directly or indirectly related to congenital genes or heredity.
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.