Introduction
Adolescent pectus excavatum is a congenital deformity of the chest wall that can have physical and psychological impacts on young individuals. Finding the right hospital for its correction is crucial. In New York City, there are several hospitals that offer high - quality treatment for this condition. This article will explore these hospitals, their approaches, and relevant information to help you make an informed decision.
Understanding Adolescent Pectus Excavatum
What is Pectus Excavatum?
Pectus excavatum, also known as sunken chest or funnel chest, occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved - in appearance. It is more common in boys than girls and often becomes more noticeable during adolescence due to rapid bone growth. According to some studies, it occurs in about 1 in 300 - 400 births and is found in 2.6 percent of children aged 7 – 14. Up to 20 percent of patients may have other skeletal conditions, such as scoliosis.
Symptoms and Complications
Young children with pectus excavatum usually have no symptoms. However, as the child reaches adolescence, the caved - in appearance may cause self - consciousness and anxiety. Physically, it can cause shortness of breath, exercise intolerance, palpitations, and in severe cases, it can shift the heart to the left side of the chest and compress the lungs, limiting the child's ability to take deep breaths. Poor posture with slumped shoulders and a protruding abdomen may also develop, and there can be problems with bone growth and alignment later in life.
Evaluation and Diagnosis of Pectus Excavatum
Doctors commonly use several methods to evaluate and diagnose pectus excavatum. Chest x - rays (both front and side views) or a chest CT scan are frequently used. To reduce radiation exposure, the severity of the deformity can often be assessed with just x - rays, and measurements like the pectus severity index or Haller index are calculated. The Haller index compares the depth of the chest cavity beneath the sternum to the width of the chest cavity (from right to left). A normal ratio of width - to - depth is about 2.5 to 1, and any calculation greater than 3.25 is considered a moderate to severe defect. Additional tests may include pulmonary function tests to check how well the lungs are working and an echocardiogram, an ultrasound of the heart to assess its function and structure.
Hospital Ranking and Overview in New York City
Columbia Surgery's Pediatric Program
Columbia's pediatric surgery program is highly regarded. It is part of the #1 ranked children's hospital in New York by U.S. News and World Report and is one of the only designated level 1 pediatric surgery centers in the northeast, according to the American College of Surgeons. For pectus excavatum correction, their surgeons have extensive experience dealing with chest wall abnormalities. They use a comprehensive approach, working closely with partners in pediatric anesthesiology, neonatology, and all pediatric medical subspecialties. Their family - centered approach is also a highlight, which includes parental visiting 24 hours a day, parental rooming - in with the child, parent support groups, a pediatric pain service, a child life center, and a Big Apple Circus clown program. They also emphasize the use of minimally - invasive techniques whenever possible, which means smaller incisions, less discomfort, shorter healing times, and less - noticeable scarring.
| Advantages | Details |
|---|---|
| Reputation | #1 ranked children's hospital in New York, designated level 1 pediatric surgery center |
| Comprehensive Care | Works with multiple specialties, family - centered approach |
| Techniques | Emphasizes minimally - invasive techniques |
UCLA Mattel Children's Hospital (though not physically in NYC but well - known for the treatment)
UCLA Mattel Children's Hospital is a leading center for treating chest deformities, including pectus excavatum. They usually recommend surgical correction of chest deformities during early adolescence to reduce the chance of the condition coming back later in life. They offer two main surgical procedures for pectus excavatum repair: the Ravitch procedure and the Nuss procedure. The Ravitch procedure is an open or modified method where an incision is made across the chest, the deformed cartilage is removed, the sternum is adjusted and repositioned, and a supportive bar is placed. The Nuss procedure is a minimally invasive technique. Two small cuts are made on either side of the rib cage, a curved, titanium bar is placed under the sternum, and it is rotated to reshape the chest. The Nuss procedure leads to less blood loss, smaller incisions, and minimal scarring with a quicker recovery time.
| Procedures | Procedure Details | Recovery Details |
|---|---|---|
| Ravitch Procedure | Chest incision, cartilage removal, sternum adjustment, bar placement | 3 - 5 days hospital stay, bar removed after about 6 months |
| Nuss Procedure | Small side cuts, bar insertion under sternum, rotation for reshaping | 1 - 2 days hospital stay, bar removed after chest healing |
Mount Sinai - New York
Mount Sinai offers two types of surgery to repair pectus excavatum: open surgery and closed (minimally invasive) surgery. Open surgery involves making a cut across the front part of the chest, removing the deformed cartilage, repositioning the breastbone, and using a metal strut to hold it in place until it heals. The closed method is mostly used for children, where two small incisions are made on each side of the chest, a video camera is inserted for visualization, and a curved steel bar is placed under the breastbone to lift it. The most common reason for the repair is to improve the appearance of the chest wall, and it can also address breathing problems in severe cases. However, like any surgery, there are risks such as reactions to medicines, breathing problems, bleeding, blood clots, or infection, as well as specific risks like injury to the heart, lung collapse, pain, and the return of the deformity.
| Surgery Type | Procedure Steps | Recovery and Risks |
|---|---|---|
| Open Surgery | Chest incision, cartilage removal, sternum repositioning, strut placement | 3 - 12 months healing, strut removed in 6 - 12 months, general and specific risks |
| Closed Surgery | Side incisions, camera insertion, bar placement | Bar left for at least 2 years, general and specific risks |
NYU Langone Health
NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for pectus excavatum. While specific details about their surgical procedures are not as extensively provided as some other hospitals, they offer a patient - centered approach. Their medical staff works to ensure that each patient receives the best treatment plan based on their individual condition and needs. Patients can browse their list of providers who treat pectus excavatum and schedule an appointment online, which adds to the convenience of accessing their services.
Johns Hopkins Children's Center (though not in NYC but with a great reputation)
The pectus program at Johns Hopkins Children's Center comprises one of the most experienced pediatric surgical teams in the country specializing in treatment for chest wall deformities. Johns Hopkins was once the home of Mark Ravitch, who perfected the original open repair of pectus excavatum that bears his name, and Alex Haller, who introduced the Haller index. Paul Colombani continued the long tradition of chest wall reconstruction expertise and modified the minimally invasive repair of pectus excavatum known as the Nuss procedure. The modified Nuss procedure at Johns Hopkins allows for decreased complications and excellent clinical results. They use the latest minimally invasive techniques to minimize scars, decrease pain, and allow a safe procedure with faster recovery rates. The preferred age for repair is around 14, as the operation is easier and the recovery is shorter in this age group, and the chest wall can re - form into a more normal shape as the child grows after the repair.
Stony Brook Medicine
Stony Brook Medicine's Chest Wall Clinic focuses on treating pectus excavatum. Their surgeons use the Nuss procedure with cryoablation to treat patients. The Nuss procedure is a minimally invasive surgery done with a laparoscope and only requires small incisions on each side of the chest. Cryoablation freezes the nerves in the chest and helps to reduce post - op pain and make recovery a little bit easier. They place a U - shaped titanium bar through one of the incisions, rotate it, and attach it to the patient's chest wall with stitches. The bar is usually kept in for two to three years and is removed with a minor surgical procedure. Patients usually stay overnight in the hospital, and opioid use is reduced due to the minimally invasive aspect and cryoablation. The overall satisfaction rating of patients after the operation is 95.6 percent.
Factors to Consider When Choosing a Hospital
Reputation
A hospital's reputation is a crucial factor. Hospitals like Columbia Surgery's pediatric program, which is ranked highly by U.S. News and World Report, have a long - standing history of providing high - quality care. Reputation often reflects the hospital's expertise, the skill of its medical staff, and the overall success rate of procedures.
Experience of the Surgical Team
The experience of the surgeons is essential. Hospitals like Johns Hopkins Children's Center, where experts like Mark Ravitch and Alex Haller made significant contributions to pectus excavatum treatment, have a team with in - depth knowledge and experience in performing the surgeries. Experienced surgeons are more likely to handle complex cases and minimize risks.
Treatment Approaches
Different hospitals may offer different treatment approaches. Some, like UCLA Mattel Children's Hospital and Stony Brook Medicine, emphasize minimally invasive techniques such as the Nuss procedure. These techniques often result in less pain, shorter recovery times, and less noticeable scarring. It's important to discuss with the medical team which approach is best for your child based on their specific condition.
Patient - Centered Care
Patient - centered care includes aspects such as family involvement, pain management, and support services. Columbia Surgery's pediatric program, for example, offers a family - centered approach with parental visiting 24 hours a day and parent support groups. Good pain management and support services can significantly improve the patient's experience during and after the treatment.
Cost and Insurance Coverage
Cost is an important consideration. Different hospitals may have different pricing structures for the procedures. It's essential to check with your insurance provider to see which hospitals are in - network and what your out - of - pocket expenses will be. You should also discuss any potential financial assistance programs that the hospital may offer.
Preparing for Pectus Excavatum Surgery
Before Surgery
Before surgery, a complete medical exam and medical tests are needed. The surgeon will order an electrocardiogram (ECG) and possibly an echocardiogram to show how the heart is functioning, pulmonary function tests to check for breathing problems, and a CT scan or MRI of the chest. You should tell the surgeon or nurse about any medicines your child is taking, including drugs, herbs, vitamins, or other supplements, as well as any allergies your child may have to medicine, latex, tape, or skin cleanser. About 7 days before surgery, your child may be asked to stop taking aspirin, ibuprofen, naproxen, warfarin, and any other blood - thinning drugs. On the day of surgery, your child will likely be asked not to drink or eat anything after midnight the night before, but you should give them any drugs the surgeon told you to give with a small sip of water.
After Surgery
After surgery, it is common for children to stay in the hospital for a few days to a week, depending on the type of surgery and the recovery progress. Pain is common after the surgery, and children may receive strong pain medicine in the vein or through a catheter placed in the spine initially, followed by oral pain medications. Tubes may be placed in the chest around the surgical cuts to drain extra fluid, and these tubes will be removed when they stop draining. After surgery, patients are generally advised to abstain from heavy physical exertion for about 6 weeks and avoid backpacks on the shoulder for three months. They can gradually resume light aerobic activities, followed by stronger cardiovascular conditioning, and then more intense sports after the initial recovery period. Regular follow - up with the pediatric surgeon is important to ensure the process is healing correctly.
Conclusion
In New York City and the broader medical landscape, there are several excellent hospitals for adolescent pectus excavatum correction. Each hospital has its own strengths, whether it's a high - ranking reputation, experienced surgical teams, innovative treatment approaches, or patient - centered care. Understanding the condition, the evaluation and treatment processes, and the factors to consider when choosing a hospital is crucial for parents and patients. By making an informed decision, you can ensure that your child receives the best possible care for pectus excavatum correction.
If you or your child is dealing with pectus excavatum, we encourage you to explore the hospitals mentioned in this article further. Contact their offices to schedule consultations, ask questions, and learn more about their specific treatment plans. Sharing this article with others who may be in need can also help spread valuable information about pectus excavatum treatment in New York City.
