Understanding Pectus Excavatum
Pectus excavatum is a relatively common congenital deformity where several ribs and the sternum (breastbone) grow abnormally, resulting in a caved - in or sunken appearance of the chest wall. It occurs more often in males than in females, and approximately 40% of people with pectus excavatum have one or more family members with the defect. While it can be present at birth, it may also develop during puberty. Although the exact causes are not fully understood, it is believed to be due to excessive growth of the cartilage connecting the ribs to the breastbone, which pulls the sternum inward.
Severe cases of pectus excavatum can have a significant impact on a person's health. It can compromise lung and heart capacity, leading to symptoms such as fatigue, shortness of breath, chest pain, and a fast heartbeat. In some instances, the proximity of the sternum to the pulmonary artery may cause a heart murmur. Additionally, it can have negative psychosocial effects, especially on children and teenagers, who may feel self - conscious and avoid activities that expose their chest.
Diagnostic Tools for Pectus Excavatum
Multiple tools are used to diagnose pectus excavatum and determine its severity:
- Visual examination of the chest: A simple yet important initial step where doctors can observe the visible characteristics of the chest wall.
- Auscultation: This involves analyzing the sounds of the heart and chest to detect the condition's effect on heart and lung function.
- Electrocardiogram (ECG or EKG): Records the electrical activity of the heart to check for any irregularities.
- Echocardiogram: A non - invasive test that uses sound waves to take a picture of the heart, helping to assess its structure and function.
- Pulmonary function testing: The patient breathes into a mouthpiece connected to an instrument that measures the amount of air breathed over a period of time, gauging lung capacity.
- Chest X - ray: Provides a basic view of the chest's skeletal structure and can show any obvious abnormalities.
- CT - scan: Offers a more detailed cross - sectional view of the chest, allowing for a more accurate assessment of the pectus excavatum's extent.
- Haller index: Calculated by obtaining the ratio of the horizontal distance of the inside of the rib cage and the shortest distance between the vertebrae and sternum. A Haller index of greater than 3.25 is generally considered severe (a normal Haller index is 2.5).
Treatment Options for Pectus Excavatum
The ideal age for surgical treatment of pectus excavatum is between 12 and 18 years, but surgery can also be effective for adults. The goal of surgery is to improve breathing, posture, and cardiac function, as well as give the chest a normal appearance. Here are the two main surgical procedures:
Nuss Procedure
The minimally invasive Nuss procedure is performed under general anesthesia. Using video - assisted thoracoscopic surgery (VATS), a horizontal passage is created underneath the sternum through two small incisions in the side of the chest. A separate, small incision allows the surgeon to view the inside of the chest with a thoracoscopic camera. A convex bar known as the Lorenz pectus bar, specially shaped to fit the individual’s anatomy, is inserted through the passage and then turned to push the sternum outward. The bar must remain in place for a minimum of three years while the chest contour re - forms to its new shape. It is then removed as an outpatient procedure. This procedure was originally developed for children but has also been successful in adults.
Modified Ravitch Repair
This procedure is also performed under general anesthesia. Using a horizontal incision, the modified Ravitch technique involves removing small pieces of deformed chest cartilage and repositioning the protruding ribs and sternum. Titanium bars are secured to the ribs and sternum to support the repaired chest architecture. Previously, the supports needed to be removed after several years, but the current bars can remain permanently in place, eliminating the need for a second operation.
Top 3 Hospitals for Pectus Excavatum Treatment in New York City
1. Mount Sinai
Mount Sinai has a highly skilled team of doctors dedicated to treating pectus excavatum. They have 7 doctors listed for “pectus excavatum” treatment, each with their own areas of expertise and locations:
| Doctor's Name | Specialty | Location | Contact Number | Rating |
|---|---|---|---|---|
| Dong - Seok Lee, MD | Thoracic Surgery | Mount Sinai Doctors, Ruttenberg Treatment Center, 1470 Madison Avenue, 3rd floor, New York, NY, 10029 | 212 - 241 - 4325 | 4.9 stars |
| Andrea Wolf, MD | Thoracic Surgery | Mount Sinai Doctors, Ruttenberg Treatment Center, 1470 Madison Avenue, 3rd floor, New York, NY, 10029 | 212 - 241 - 9502 | N/A |
| Daniel G Nicastri, MD | Thoracic Surgery | Mount Sinai Doctors - Yonkers, 1086 North Broadway, Yonkers, NY, 10701 | 212 - 241 - 6845 | N/A |
| Brian Housman, MD | Thoracic Surgery, Surgery | Mount Sinai Doctors - Greenlawn, 5 Cuba Hill Rd, Greenlawn, NY, 11740 | 631 - 628 - 5000 | N/A |
| John Tackett, MD, MHS | Surgery | The Mount Sinai Hospital, 5 E 98th st., 14th floor, Suite C, New York, NY, 10029 | 212 - 241 - 1608 | 4.9 stars |
| Andrew J Kaufman, MD | Thoracic Surgery, Surgery | Mount Sinai Doctors, Ruttenberg Treatment Center, 1470 Madison Avenue, 3rd floor, New York, NY, 10029 | 212 - 241 - 8842 | N/A |
| Raja M Flores, MD | Surgery, Thoracic Surgery | Mount Sinai Doctors, 1470 Madison Avenue, New York, NY, 10029 | 212 - 241 - 9466 | N/A |
At Mount Sinai, the team of surgeons has joined forces to diagnose and manage chest wall conditions. They work with world - class colleagues in pediatric and adult cardiology, pulmonology, genetics, orthopedic surgery, radiology, anesthesiology, and orthopedics. They also collaborate with interventionists and physical therapists to provide the latest treatment methods and surgical innovations. The hospital conducts research to develop more effective treatments and explore ways to prevent or improve chest wall conditions. For example, they have already developed specialized instrumentation for chest wall surgery, which improves the process and outcomes. Currently, they are using whole genome analysis to explore hereditary aspects of chest wall conditions.
2. New York - Presbyterian / Columbia University Irving Medical Center
Dr. Lyall A. Gorenstein, who practices at this hospital, specializes in thoracic surgery, with a special focus on minimally invasive thoracic surgery, hyperhidrosis - palmar, and pectus excavatum. He graduated from Canada in 1983 and completed his training at Univ Toronto Affil Hosp, UT MD Anderson Canc Ctr, and Univ Toronto Affil Hosp. He is board - certified in surgery and thoracic surgery.
The hospital's Chest Wall Abnormalities Program at ColumbiaDoctors Children's Health is also notable. Their multidisciplinary medical team evaluates, monitors, and treats children and adolescents with a range of chest wall anomalies, including pectus excavatum. The team consists of pediatric surgeons, doctors from other pediatric specialties such as orthopedic surgery, plastic surgery, cardiology, pulmonology, genetics, and radiology, as well as nurse practitioners, orthotists, and physical therapists. They have extensive experience in using a minimally invasive approach to treat pectus excavatum and in addressing pectus carinatum with bracing rather than surgery. They also care for children with severe, complex abnormalities affecting both the chest wall and spine.
Patients can make an appointment by calling 212 - 342 - 8585.
3. NYU Langone Health
NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for pectus excavatum. Although specific details about individual doctors were not provided in the given references, their website allows patients to browse a list of providers who treat pectus excavatum and schedule an appointment online. This indicates a commitment to patient - centered care and easy access to treatment options.
The hospital is likely to offer a comprehensive approach to pectus excavatum treatment, including access to the latest surgical techniques and post - operative care. Their team may also have expertise in addressing the psychosocial aspects of the condition, which are important for the overall well - being of patients, especially children and adolescents.
Other Considerations for Pectus Excavatum Treatment
Cost of Treatment
The cost of pectus excavatum treatment can vary widely depending on the hospital, the surgical procedure used, and the patient's insurance coverage. The Nuss procedure, being minimally invasive, may have a different cost structure compared to the modified Ravitch repair. Insurance companies may cover a significant portion of the cost, but patients should always check with their insurance provider beforehand to understand their benefits and any out - of - pocket expenses they may incur.
Recovery and Aftercare
Recovery after pectus excavatum repair varies depending on the person’s age and the amount of chest depression. After surgery, most people leave the hospital within 3 to 5 days and can return to school or work within two to three weeks. However, they must avoid vigorous exercise for the first month after surgery and contact sports for three months after surgery. Patients will also need to attend follow - up appointments with their doctors to monitor their healing process and ensure that the chest is re - forming properly.
Psychosocial Support
As mentioned earlier, pectus excavatum can have a significant impact on a patient's self - esteem and social interactions, especially in children and teenagers. Many hospitals recognize this and may offer psychosocial support services such as counseling or support groups. These services can help patients and their families cope with the emotional challenges associated with the condition and the treatment process.
Conclusion
Pectus excavatum is a congenital condition that can have both physical and psychosocial effects on patients. However, with the advancements in surgical techniques and the expertise of hospitals in New York City, effective treatment options are available. Mount Sinai, New York - Presbyterian / Columbia University Irving Medical Center, and NYU Langone Health are among the top hospitals in the city for pectus excavatum treatment, each offering specialized care and a multidisciplinary approach.
If you or someone you know is dealing with pectus excavatum, it is crucial to consult with a medical professional. Reach out to one of these top hospitals to schedule a consultation and explore the treatment options available. Share this article with others who may benefit from this information, and continue to educate yourself about pectus excavatum and related health topics.
