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Funnel chest (pectus excavatum)
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.
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.
Minimally invasive surgery for pectus excavatum
Pectus excavatum minimally invasive surgery currently comes in two varieties. The first resembles a variation of the traditional Nuss procedure, which involves making a small incision under the patient's armpit and inserting a pre-shaped trapezoidal steel plate through this small hole to the back of the depressed breastbone. The steel plate is then flipped to push out the depression. Because it requires only a one to two centimeter incision on the patient, it is considered much less invasive compared to the traditional Nuss procedure which requires two incisions. There is also another type of minimally invasive surgery which involves bilateral incisions but does not require flipping the steel plate, thus avoiding damage associated with flipping and muscle disruption between the ribs. This is also considered a current minimally invasive surgical technique. Additionally, there is the recent Wang procedure, which is also minimally invasive, requiring only one incision and not necessitating access behind the breastbone. However, it is generally suitable only for younger patients with softer breastbones. For older adults, the Wang procedure might not be appropriate and further observation is required.
Pectus Excavatum should visit which department?
Pectus excavatum should be consulted with which department? Pectus excavatum is a type of congenital chest wall deformity, accounting for over 90% of all anterior chest wall deformities, and is primarily characterized by a depression in the middle of the chest wall that sinks inward and backward. As it is a congenital deformity, it can be noticed in children soon after birth, around the age of three to five, especially during bathing. This deformity may worsen with the patient's age, so you might consider consulting the pediatric health department. However, this indentation usually intensifies during puberty, and the pediatric health department primarily provides consultation services. If you seek a comprehensive assessment and treatment for pectus excavatum, you should consult the thoracic surgery department, which offers a range of treatments from surgical to non-surgical methods. Therefore, it is recommended to first consult the thoracic surgery department, followed by the pediatric health department.
Pectus excavatum causes
The etiology of pectus excavatum is not fully clear yet, but it has been found that the incidence of pectus excavatum greatly increases among patients with connective tissue diseases, possibly related to the disruption of the balance between growth genes and inhibitory genes affecting the cartilage on both sides of pectus excavatum. Moreover, it is also found that the complication of pectus excavatum significantly increases among patients with Marfan syndrome (also a type of connective tissue disease) and Noonan syndrome. In children with congenital airway stenosis and bronchopulmonary dysplasia, the incidence of pectus excavatum also significantly increases. This suggests that the causes of pectus excavatum are directly or indirectly related to genetics and heredity, and regardless, the causes of pectus excavatum, both acquired and congenital, are directly related to genes and heredity.
Best age for pectus excavatum surgery
The best age for funnel chest surgery, according to the latest and most authoritative ninth edition of the surgical textbook, is between three and five years old. Historically, there has been controversy over the best age for funnel chest surgery, with some pediatricians previously believing it should wait until adolescence. However, it has been found that by the age of five, children start to become more aware and might realize their chest shape differs from others, potentially leading to feelings of inferiority and reluctance to make friends. Thus, performing the surgery before the age of five—before the child is fully aware of their deformity—might actually be preferable, as it could minimize psychological and physiological impacts. Of course, there is also a viewpoint supporting surgery before the age of three, but the younger the child, the softer the chest bone, which sometimes allows for other potential corrective methods.