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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
Is pectus excavatum hereditary?
Is pectus excavatum hereditary? According to modern genetic medicine, actually, about 80% of diseases are related to genetics to some extent, and pectus excavatum is no exception. Normally, pectus excavatum occurs in about one in 400 to 1000 people, with a higher prevalence in males. Research has also found that pectus excavatum is often seen in several genetic disorders, including Noonan syndrome, Turner syndrome, and Marfan syndrome. This indicates that it shares certain genes with these genetic disorders, such as the fibrillin-1 gene and others in the RAS/MAPK pathway. These genetic correlations may not always be evident, for example, the parents may not have pectus excavatum themselves. However, when parents with these recessive genes reproduce, their combination might result in pectus excavatum in their child. The development of pectus excavatum might be related to abnormal asymmetrical development of the cartilage. Thus, there is indeed a certain correlation between pectus excavatum and genetic factors.
Does a ventricular septal defect affect development?
Does a ventricular septal defect affect development? For relatively small ventricular septal defects, such as those under five millimeters, the shunt from the left ventricle to the right ventricle is minimal, hence patients may not exhibit noticeable symptoms. However, if the defect is larger, for instance, over five millimeters, a large volume of blood will flow from the left ventricle into the right ventricular system. This causes congestion in the right ventricular system and the pulmonary circulation will be flooded with blood. As the saying goes, "flowing water does not rot, nor do door hinges become worm-eaten"; however, when a large amount of blood accumulates in the pulmonary vessels, patients are prone to recurrent respiratory infections and even congestive right heart failure, which then leads to feeding difficulties. Patients feel consistently uncomfortable and have difficulty breathing, so they may be reluctant to eat, especially in young children who need considerable effort to drink milk, which requires some breath-holding. At this time, patients experience feeding difficulties, which equates to developmental delays. Therefore, larger ventricular septal defects can affect a child's development. Small defects, such as those under three millimeters, might not affect development, but larger defects do impact development and thus require timely treatment.
How to exercise to correct pectus excavatum
Pectus excavatum refers to the inward and backward indentation of the sternum, a deformity that can compress the patient's heart and lungs. To exercise for pectus excavatum, patients are advised to practice deep breathing exercises to enhance lung function, as well as engage in appropriate running and routine physical activities to strengthen heart function. However, in cases of severe pectus excavatum which severely compresses the heart, even pushing it entirely to the left side, patients may not be able to tolerate running and other intense activities. Therefore, it is quite difficult to completely correct pectus excavatum through exercise alone. Some parents might think that doing push-ups can correct pectus excavatum, but push-ups make the pectoral muscles on both sides stronger, and since these muscles pull outward, the force is not directed in the same way as the inward and backward indentation of pectus excavatum. Furthermore, continuously training the pectoral muscles causes them to develop, and the resultant thickening of the muscles on both sides can exacerbate the inward and backward indentation of the sternum in the middle. Thus, after appropriate cardiovascular and pulmonary exercises, those with severe pectus excavatum should still consult a doctor for active advice and consider surgical treatment options.
Postoperative complications of pectus excavatum surgery
In theory, if the pectus excavatum surgery is successful, there won't be many long-term complications. However, if we have to discuss possible complications or side effects, they can be categorized as either short-term or long-term. For instance, pectus excavatum itself involves the inward and backward indentation of the sternum, which compresses the patient's heart and lungs. The surgery corrects this by pushing or suspending the indented sternum forward. Due to the alteration in the shape and appearance of the bones, the patient may experience some pain post-surgery, but this pain is bearable and usually subsides within three to five days. Particularly in younger children, who have softer bones, normal activities can often be resumed in just a day or two. However, as age increases and bones become harder, patients may feel pain for about three to five days to a week post-surgery, but typically return to normal after a week. Additionally, there might be complications such as pneumothorax, pleural effusion, or even severe cardiac damage. However, these are generally problems that arise from unsuccessful operations or issues that can be resolved in the short term. Therefore, in the long term or over an extended period, there are generally no lasting side effects from pectus excavatum surgery. If there has to be mention of any, it would be the surgical scars left under the armpits, typically one to two scars each measuring 1 to 2 centimeters.
Causes of Pectus Excavatum
Although current medicine has developed to the molecular and genetic levels, the true causes of many modern diseases are still not completely clear, which includes pectus excavatum. There have been medical cases indicating that scientists have never ceased to explore the causes of pectus excavatum. It was once believed by early medical scientists that pectus excavatum might be caused by the inward and backward pulling of the sternum by the diaphragm. Therefore, for a period, the treatment for pectus excavatum involved releasing adhesions of the diaphragm, but this method was later found to be ineffective for children and was abandoned. Subsequently, it was discovered that pectus excavatum is somewhat related to the genetics of many families, such as those with Marfan syndrome (an autosomal dominant hereditary connective tissue disorder) and Noonan syndrome (a genetic disorder caused by mutations). However, no definitive pathogenic genes have been identified in families with sporadic cases of pectus excavatum. In summary, pectus excavatum is currently believed to be possibly caused by factors such as the development of rib cartilage on both sides, genetics, and other acquired conditions, like underdeveloped laryngeal cartilage or post-surgical factors from congenital diaphragmatic hernia repair. Overall, the causes of pectus excavatum are still actively being explored by medical scientists.
Difference between funnel chest and pigeon chest
Pectus excavatum and pectus carinatum are both types of deformities of the anterior chest wall, with pectus excavatum being the most common deformity, accounting for 90% of all anterior chest wall deformities; the incidence of pectus carinatum is only one-fifth to one-sixth of that of pectus excavatum. The shapes of pectus excavatum and pectus carinatum are also completely different. Pectus excavatum appears as if a funnel were placed on the chest, with the funnel receding backward and downward. Therefore, patients with pectus excavatum, when lying down, can observe a depression in the front of their chest, which is even capable of holding a cup of water placed within this funnel-like depression. On the other hand, the deformity in pectus carinatum protrudes forward. One caves inward while the other protrudes forward, thus these two shapes are completely opposite.