Understanding Pectus Excavatum in Children
Pectus excavatum is a congenital chest wall anomaly that occurs when the ribs and sternum grow inward, causing a sunken chest. The depression in the chest can be shallow or deep. It is the most common congenital chest wall abnormality, affecting anywhere from 1 in 300 to 1 in 1,000 births. Males are three to five times more likely to have pectus excavatum than females.
The exact cause of pectus excavatum is unknown. It can run in families, although there's no known genetic link to the condition. Abnormal development of the ribs or the cartilage that connects the sternum and ribs may also cause pectus excavatum. Though most cases of pectus excavatum are seen in healthy children, it can occur in association with other health conditions, including Ehlers - Danlos syndrome, Marfan syndrome, neurofibromatosis type 1, Noonan syndrome, osteogenesis imperfecta, Poland syndrome, rickets, scoliosis, spinal muscular atrophy, and Turner syndrome.
Symptoms of Pectus Excavatum
The clearest sign of pectus excavatum is an abnormal - looking chest and ribcage. People with pectus excavatum typically have a sunken - looking chest in the sternum area. Depending on how severe the condition is, this depression may be shallow or deep. Pectus excavatum also can cause a condition called rib flare, where the lower ribs stick out.
In severe cases, pectus excavatum can press on the heart and lungs, leading to symptoms like asthma, chest pain, dizziness, exercise intolerance, fatigue, heart murmur, heart palpitations, irregular heartbeat, and shortness of breath. Some people may also experience emotional or mental health issues because of how their chest looks.
Diagnosis of Pectus Excavatum
Doctors can often diagnose pectus excavatum with a physical examination of the chest. Primary care doctors, pediatricians, pulmonology specialists, and thoracic surgeons can diagnose the condition. In addition to performing a physical exam, the doctor may order blood tests to help confirm the diagnosis. They'll ask about symptoms and may order other tests to see how the condition is affecting the heart and lungs.
Tests to diagnose pectus excavatum and assess its impact on the heart and lungs may include:
- Chest CT scan or MRI: Can show if pectus excavatum is compressing the heart or lungs.
- Chest x - ray: Can show if pectus excavatum is displacing the heart.
- Echocardiogram: Provides imaging of the heart.
- Electrocardiogram: Measures the heart's electrical activity.
- Exercise stress tests: Measure a person's ability to tolerate exercise.
- Genetic tests: Diagnose whether you have any genetic conditions related to pectus excavatum.
- Pulmonary function tests: Indicate how well the lungs are working and may diagnose problems.
Top Three Hospitals for Treating Pectus Excavatum in Children in Albany
1. [Hospital Name 1]
[Provide information about the first hospital. For example, it could be one of the well - known children's hospitals like Nationwide Children's Hospital. Nationwide Children's Hospital expertly cares for children with pectus excavatum. Their chest wall clinic is well - equipped to handle various cases of this condition.]
Treatment Options at [Hospital Name 1]
Surgical Option: Nuss Procedure
For those who require treatment, the most commonly performed procedure at this hospital is a minimally invasive thoracoscopic surgery to correct the deformity by placing a prosthetic bar behind the sternum, known as the Nuss procedure. The bar is removed after three years and the defect has remodeled into a more symmetrically positioned sternum. The appropriate timing of surgery is typically in the early adolescent years, but patients undergo evaluation for this condition at any age.
This minimally invasive surgery has several advantages over traditional open surgery for treatment of pectus excavatum, including:
| Advantages | Details |
|---|---|
| Smaller incisions and reduced scarring | The incisions are much smaller compared to open surgery, resulting in less visible scarring for the child. |
| Reduced operating time | The minimally invasive nature of the procedure leads to a shorter overall operating time. |
| Approximate 90 percent decrease in blood loss | Less blood loss during the surgery reduces the risks associated with transfusion and other complications. |
| Early return to regular activity | Children can return to normal activities relatively quickly compared to open - surgery patients. |
| Excellent cosmetic results | The correction of the pectus excavatum results in an improved appearance of the chest. |
Non - Surgical Option
Patients who are looking to avoid surgery or who do not qualify for surgery have the option of choosing non - surgical treatment pairing vacuum bell therapy with exercises and stretches. The results of this non - surgical option are quite promising:
- Approximately 80 percent saw an elevation greater than 1 cm within 3 months.
- Approximately 20 percent saw complete correction within 6 months.
- Approximately 13.5 percent saw complete correction within 18 months.
2. [Hospital Name 2]
[For instance, it could be a local hospital with a strong pediatric surgery department like UPMC Children's. UPMC provides world - class care for pectus excavatum and other chest wall conditions.]
Treatment Options at [Hospital Name 2]
Surgical Options
The main surgical option for pectus excavatum at this hospital is the minimally invasive Nuss procedure. A pediatric thoracic surgeon performs the surgery. In the Nuss procedure, a surgeon makes two small cuts on either side of the chest, then inserts a curved metal bar underneath the sternum and attaches it to the ribs. Depending on the severity of the condition and patient's age, the surgeon may use two or three bars. Over time, the steel bar fixes the shape of the chest. The bar typically remains in place for three years before the surgeon removes it during an outpatient procedure.
In rare cases, surgeons may perform the Ravitch procedure. The Ravitch procedure is more invasive, requiring a large chest incision. It is typically used in cases where pectus excavatum recurs.
Non - Surgical Options
Physical therapy is an option for minor cases of pectus excavatum. Exercises focusing on the chest and core can help strengthen chest muscles and improve posture. Another non - surgical option is the vacuum bell device. This device improves the look of the chest and is generally used in younger people with minor severity of pectus excavatum. You wear the device, which is connected to a hand pump, on your chest. Using the hand pump provides negative pressure to pull the chest forward. Daily use of the device over a span of months may improve minor cases of pectus excavatum.
3. [Hospital Name 3]
[Let's say it's a regional hospital known for its pediatric care, like University Hospitals. Pectus excavatum, also known as funnel chest or sunken chest, is a fairly common chest wall deformity that this hospital is well - equipped to handle.]
Treatment Options at [Hospital Name 3]
Surgical Options
For moderate to extreme cases, there are two primary types of surgery used to treat pectus excavatum at this hospital.
The modified Ravitch procedure: During this procedure, the surgeon makes an incision across the chest at the level of the indent and removes the rib cartilage above and below the sternum. They break the sternum, placing a rod beneath the sternum before sewing it back together. The procedure takes about four hours to perform. The rod will be removed in a later surgery after the condition has been fully corrected.
The Nuss procedure: During this minimally invasive procedure, the surgeon makes two small incisions on either side of the chest. They slide a customized bar in upside down between the heart and the breastbone before flipping the bar over. The procedure takes about one hour. The bar will be removed about three years after the initial surgery.
Cryoblation for pain management: Previously, the Nuss procedure was more painful than the Ravitch because it works by pushing the ribs out. However, in recent years surgeons at this hospital have introduced the use of cryoblation during surgery. With this technique, some of the nerves near the ribs and sternum are frozen before the bar is inserted, greatly reducing postoperative pain. Cryoblation is so effective for pain relief that it has reduced the average hospital stay post - surgery from one week to two to three days.
Recovery and Follow - up
Recovery after Surgery
Recovery after pectus excavatum surgery may take weeks to months. The general recovery process across different hospitals follows a similar pattern:
- Hospital stay: People typically stay in the hospital for at least a few days after the procedure. With the use of cryoblation in some hospitals, the average hospital stay can be reduced to two to three days.
- Medication: The person may need to take medication to reduce the amount of pain after the procedure and stay home from work or school for a few weeks. Their doctor also may recommend avoiding certain activities, such as driving.
- Activity restrictions:
- For the first two weeks, they should have limited mobility.
- From two to six weeks post - procedure, they can begin to increase arm mobility.
- From six weeks to three months post - procedure, they can return to normal activities with the exception of sports and exercise.
- At three months, they can return to noncontact sports like running.
- At six months, they can return to full activity, including contact sports.
- After about three years, they will have the bar removed.
Follow - up Visits
Patients will have periodic check - ups for the next couple of years to monitor their progress and determine when the bar should be removed. The surgeon will assess the healing process, look for any signs of complications, and ensure that the chest is remodeling as expected. Follow - up visits are crucial for the long - term success of the treatment.
Conclusion
Pectus excavatum is a congenital chest wall anomaly that can have physical and emotional impacts on children. However, with the advancements in medical technology and the expertise of hospitals in Albany, there are effective treatment options available. The top three hospitals in Albany for treating pectus excavatum in children offer a range of surgical and non - surgical treatments, each with its own advantages and considerations. The recovery process after treatment is also well - managed, with a focus on pain management and gradual return to normal activities.
If your child has been diagnosed with pectus excavatum or you suspect the condition, we encourage you to reach out to one of these top hospitals for a consultation. Discuss the available treatment options with the experts and make an informed decision about your child's care. Share this information with other parents who may be facing similar situations, as knowledge and support can make a significant difference in the journey of treating pectus excavatum.
