Introduction to Pectus Excavatum
Pectus excavatum, also known as concave chest or funnel chest, is a chest wall deformity where a child's breastbone (sternum) and some of the ribs grow inward, causing a depression in the middle of the chest. This condition can range from mild to severe, depending on the depth of the indentation. In many cases, it may not be noticeable at birth and can go undetected until puberty. During growth spurts, the indentation often becomes more pronounced.
Symptoms of Pectus Excavatum
The symptoms of pectus excavatum vary with age. In infants, it may present as a hollow depression in the chest, which can be broad and shallow, deep and narrow, or irregular. They may also have more rapid breathing than normal. For older children, symptoms can include shortness of breath upon exertion or exercise, chest pain, a lateral curvature of the spine and absence of the curve of the upper back, hooked shoulders, and a broad, thin chest. A study of 375 patients who underwent repair of pectus excavatum deformities at UCLA Medical Center from 1969 - 1999 reported that 67% of patients experienced a decrease in stamina and endurance during exercise, 32% had frequent respiratory infections, 8% had chest pain, and 7% had asthma.
Causes of Pectus Excavatum
There is currently no known definitive cause for pectus excavatum. Although the majority of affected children do not have a family history, a sufficient number do, leading doctors to suspect that genes may play a significant role. As a result, researchers are actively investigating a genetic component.
Complications of Pectus Excavatum
In severe cases, the sternum and ribs can press on a child's heart and lungs. However, this usually only affects heart and lung function during extreme exercise and not usually in a major way. Approximately 15 percent of children with pectus excavatum also develop scoliosis (curvature of the spine). It can also be associated with connective tissue disorders such as Marfan syndrome or Ehlers - Danlos syndrome (EDS), although this is rare.
Diagnosis and Treatment of Pectus Excavatum
Diagnosis
Pectus excavatum is usually diagnosed during a physical examination. X - rays of the chest can help confirm the diagnosis. At Boston Children's Hospital, a white light scanner, a type of three - dimensional (3D) camera, is also used to measure the chest wall depression and monitor the response to treatment over time. Other recommended tests might include an echocardiogram (also known as cardiac ultrasound), a pulmonary function test (PFT), and a cardiopulmonary exercise test (CPET).
Treatment
Non - surgical Treatment: Vacuum Bell Therapy
If a child has a mild case of pectus excavatum, they may not need treatment as a shallow indentation may not affect heart or lung function or the appearance of the chest. However, if it is causing physical or social problems, non - surgical treatment can be considered. Vacuum bell therapy uses a device worn on the outside of the body to create suction and lift the breastbone forward over time. It typically works best for younger children with mild pectus excavatum and flexible chest walls. The child needs to wear the device for a total of four hours every day, and the therapy usually takes at least two years, depending on the child's growth.
Surgical Treatment
If the pectus excavatum is more severe or does not improve with vacuum bell therapy, there are two surgical options:
- Minimally Invasive Repair (Nuss Procedure): A surgeon makes small cuts on each side of the chest and inserts a curved bar under the breastbone. The bar, shaped to the contours of the child's chest, presses the breastbone forward. Sometimes more than one bar is needed. The bar usually remains in the chest for three years while the breastbone grows around it. Removing the bar is a simple procedure.
- Open Repair (Ravitch Procedure): An open surgery where the surgeon makes a cut across the front of the chest and removes the cartilage causing the breastbone to grow inward. The surgeon then reshapes the breastbone and may place a metal bar to hold it in place while it heals. The bar usually remains in place for six to 12 months while new cartilage grows.
The benefits of treating pectus excavatum can be both physical and psychological. In severe cases, repairing the chest wall may improve the function of the heart and lungs. In most cases, the biggest benefit is an improvement in self - confidence if the child is upset about the appearance of their chest.
Best Hospitals in Albany for Pectus Excavatum Surgery
When it comes to finding the best hospitals for mild and moderate pectus excavatum surgery in Albany, several factors need to be considered, such as the hospital's experience, the expertise of the surgeons, and the quality of care provided. Let's take a look at some of the top - ranked hospitals in Albany:
St. Peter's Hospital - Albany
St. Peter's Hospital is ranked #1 in Albany by U.S. News & World Report for 2024 - 2025. It is also named a best regional hospital and is ranked 17th in New York State. This is the 11th consecutive year the hospital has received the best regional hospital designation. St. Peter's Hospital is ranked as a high - performing hospital for two adult specialties (gastroenterology/gi surgery and urology) and 12 conditions/procedures, including aortic valve surgery, colon cancer surgery, chronic obstructive pulmonary disease (COPD), heart attack, heart bypass surgery, heart failure, hip replacement, kidney failure, knee replacement, lung cancer surgery, pneumonia, and prostate cancer surgery.
The Albany Thoracic & Esophageal Surgery, located in the professional medical office building adjacent to St. Peter’s Hospital, provides comprehensive and compassionate surgical care to patients with chest - related diseases, including pectus excavatum. Their highly trained and skilled surgeons possess the diagnostic tools, surgical skills, and knowledge for the entire treatment process, from pre - operative work - up to post - operative care and long - term follow - up. They also offer a full spectrum of endoscopy procedures of the lungs and esophagus, as well as dilation, stenting, and laser procedures. Minimally invasive surgical approaches are used whenever indicated for both benign and malignant chest pathology.
Albany Medical Center
Albany Medical Center is ranked #2 in Albany. It is rated high - performing in 13 adult procedures and conditions. It is a general medical and surgical facility and a teaching hospital. The evaluation of the center also includes data from Albany Medical Center South - Clinical Campus.
The hospital has a team of experienced doctors in various specialties. For pectus excavatum surgery, patients can benefit from the combined expertise of multiple departments. In terms of surgical options, it is likely to offer both minimally invasive and open surgical procedures, depending on the patient's condition. The hospital's ranking in various specialties such as cardiology, heart & vascular surgery, and orthopedics indicates its comprehensive capabilities in handling different aspects related to pectus excavatum surgery and post - operative care.
Ellis Hospital
Ellis Hospital in Schenectady, which is part of the Albany area, is also a notable option. It is high - performing in 5 procedures/conditions. While it may not have the same number of high - performing specialties as St. Peter's or Albany Medical Center, it still offers quality care. In the field of thoracic surgery, which is relevant to pectus excavatum, the hospital's surgical team has the skills and experience to provide appropriate treatment. Their focus on specific procedures and conditions ensures that patients receive specialized care.
Comparison of Hospitals
| Hospital Name | Albany Ranking | High - Performing Specialties/Procedures | Facilities and Services | Expertise in Pectus Excavatum Surgery |
|---|---|---|---|---|
| St. Peter's Hospital - Albany | #1 | 2 adult specialties and 12 conditions/procedures | Comprehensive inpatient and outpatient services, specialized thoracic surgery center | Experienced surgeons, full - spectrum of diagnostic and treatment options |
| Albany Medical Center | #2 | 13 adult procedures and conditions | General medical and surgical facility, teaching hospital, multiple specialty departments | Team of experienced doctors, offers multiple surgical options |
| Ellis Hospital | - | 5 procedures/conditions | Quality care in specific procedures, surgical team with relevant skills | Skilled surgical team for thoracic - related surgeries |
Factors to Consider When Choosing a Hospital for Pectus Excavatum Surgery
Hospital Reputation
A hospital's reputation is an important factor. Rankings by trusted organizations like U.S. News & World Report can give an indication of the hospital's overall quality and performance. Hospitals with a long - standing reputation for excellence in surgical care are more likely to have experienced surgeons and a high - quality support staff.
Surgeon Expertise
The expertise of the surgeon performing the pectus excavatum surgery is crucial. Look for surgeons who have extensive experience in performing both minimally invasive and open pectus excavatum repairs. You can ask about the surgeon's success rate, the number of similar surgeries they have performed, and their training and certifications.
Quality of Care
Quality of care includes factors such as patient safety, infection control, and post - operative follow - up. A hospital with a high standard of quality care is more likely to have better patient outcomes. You can check hospital ratings and reviews from patients to get an idea of the quality of care provided.
Available Facilities
Modern and well - equipped facilities can enhance the surgical experience and outcomes. Facilities such as advanced diagnostic tools, state - of - the - art operating rooms, and dedicated recovery units are important. For example, a hospital with access to 3D scanning technology can more accurately diagnose and plan the surgery for pectus excavatum.
Cost and Insurance Coverage
Cost is also a consideration. Make sure to check with your insurance provider to understand what is covered. Different hospitals may have different pricing structures for the same surgery. It's important to have a clear understanding of the total cost, including pre - operative tests, the surgery itself, and post - operative care.
Conclusion
The newly released hospital ranking list for mild and moderate pectus excavatum surgery in Albany provides valuable information for patients and their families. St. Peter's Hospital, Albany Medical Center, and Ellis Hospital are all top - tier hospitals in the area, each with its own strengths and capabilities. When choosing a hospital for pectus excavatum surgery, it is essential to consider factors such as hospital reputation, surgeon expertise, quality of care, available facilities, and cost. By carefully evaluating these factors, patients can make an informed decision and choose the hospital that best meets their needs.
If you or someone you know is considering pectus excavatum surgery, we encourage you to further research these hospitals, consult with medical professionals, and read patient reviews. Don't hesitate to ask questions and gather as much information as possible to ensure the best possible outcome. Share this article with others who may find it helpful in their search for the right hospital for pectus excavatum surgery.
