Pectus excavatum should see which department?

Written by Zhang Zhi Gong

Cardiothoracic Surgery

Updated on December 09, 2024

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If the patient is relatively young, under 14 years old, and wishes to consult about pectus excavatum care, pediatric healthcare can be considered. However, if the patient is older, or in addition to pediatric healthcare advice, seeks information on how to treat pectus excavatum, it is advisable to consult with a local thoracic surgery department, if available. This is because thoracic surgeons offer not only information on the causes or care of pectus excavatum but also treatment options. Both conservative treatment plans and surgical interventions are available from thoracic surgeons. Of course, not all hospitals have a department of thoracic surgery, but general top-tier hospitals typically do; if there is no thoracic surgery available locally, considering general surgery might be the only alternative.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

55sec

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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.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

1min 32sec

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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.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

1min 44sec

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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.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

1min 19sec

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Can funnel chest heal itself?

Actually, a portion of children with pectus excavatum can heal on their own, especially those who are newly born and discovered to have pectus excavatum. This is because children are curled up while in the mother's womb. In some cases, their hands and feet might be placed in front of the sternum, pressing it backward and inward, causing a deformity. However, once the mother gives birth and the child's limbs unfold, the pressure on the sternum is relieved. As the chest grows, it gradually returns to its normal shape, and these children with pectus excavatum can be cured. On the other hand, another group of patients do not have pectus excavatum at birth, but develop a noticeable chest indentation as they grow older. These patients, when they are young, can also be treated with conservative methods, such as using a vacuum bell for pectus excavatum to gradually draw the indentation outward. With its stabilizing effect, as the child grows, the deformity can be slowly corrected. Of course, there are also children who might have a more rapid skeletal development, and essentially become "set" in their ways. At this stage, they may require surgical intervention to treat the condition. In summary, a portion of pectus excavatum patients can be healed, while another portion requires active intervention and treatment.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

48sec

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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.