Introduction
Pectus excavatum is a relatively common congenital deformity where the chest wall is sunken in, creating a caved - in appearance. In adults, severe cases of pectus excavatum can affect lung capacity, causing fatigue, shortness of breath, chest pain, and a fast heartbeat. For those seeking surgical treatment in New York City, several hospitals offer advanced procedures and expert care. This article will explore the top hospitals in New York City that perform adult pectus excavatum surgery.
What is Pectus Excavatum?
Pectus excavatum is a malformation of the chest wall in which several ribs and the sternum (breastbone) grow abnormally, resulting in a sunken appearance. 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. Often present at birth, the condition may also develop during puberty and can range from mild to severe. Although its causes are not completely understood, it is believed to arise from excessive growth of the cartilage connecting the ribs to the breastbone, which pulls the sternum inward.
Symptoms of severe pectus excavatum can include compromised lung and heart capacity, leading to fatigue, shortness of breath, chest pain, and a fast heartbeat. In some cases, a heart murmur may occur due to the proximity of the sternum and the pulmonary artery. The condition can also have negative psychosocial effects on children and teenagers, and the symptoms may worsen in adulthood if left untreated.
Diagnosis of Pectus Excavatum
Doctors use multiple tools to diagnose pectus excavatum and gauge its extent:
- Visual examination of the chest: A simple yet important first step to observe the appearance of the chest wall.
- Auscultation: Analysis of sounds of the heart and chest to detect the condition's effect on heart and lung function.
- Electrocardiogram (ECG or EKG): This test records the electrical activity of the heart and can help detect any heart - related issues associated with pectus excavatum.
- Echocardiogram: A non - invasive test that takes a picture of the heart with sound waves, providing detailed information about the heart's structure and function.
- Pulmonary function testing: Involves breathing into a mouthpiece connected to an instrument that measures the amount of air breathed over a period of time, helping to assess lung capacity.
- Chest x - ray: Provides a basic view of the chest bones and can show the general shape of the chest.
- CT - scan: Offers a more detailed 3D view of the chest, allowing doctors to accurately measure the severity of the deformity. The Haller index, calculated from the CT scan, is often used to determine the severity of pectus excavatum. A Haller index of greater than 3.25 is generally considered severe (a normal Haller index is 2.5).
Surgical Treatments for Pectus Excavatum
Nuss Procedure
The minimally invasive Nuss procedure is performed with general anesthesia. Using video - assisted thoracoscopic surgery (VATS), the surgeon creates a horizontal passage underneath the sternum through two small incisions in the side of the chest. A separate, small incision enables 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. The bar is removed as an outpatient procedure. Many adults have undergone this minimally invasive pectus repair, and the results appear to be as good as with the modified Ravitch procedure.
Modified Ravitch Repair
Performed under general anesthesia, the modified Ravitch technique involves making a horizontal incision and removing small pieces of deformed chest cartilage. The protruding ribs and sternum are then repositioned. 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, avoiding the need for a second operation.
Hospitals in New York City for Adult Pectus Excavatum Surgery
NYU Langone Health
NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for pectus excavatum. The hospital offers a comprehensive approach to treatment, with a team of experts who can diagnose and treat the condition. Patients can browse the list of providers who treat pectus excavatum on their website and schedule an appointment online. The hospital's doctors have extensive experience in both the Nuss procedure and the modified Ravitch repair, ensuring that patients receive the most appropriate treatment for their specific case.
NewYork - Presbyterian Queens
NewYork - Presbyterian Queens has a highly sophisticated minimally invasive thoracic surgery program. The thoracic surgeons at this hospital, in collaboration with Weill Cornell Medicine, provide the latest in surgical techniques and comprehensive care for patients with pectus excavatum. They offer minimally invasive Nuss procedures for pectus excavatum, among other advanced surgical options. The hospital's multidisciplinary team of thoracic surgeons, medical and radiation oncologists, pulmonologists, gastroenterologists, radiologists, pathologists, neurologists, physician assistants, nurse practitioners, dedicated thoracic intensive care nurses, respiratory therapists, speech therapists, and social workers collaborates to deliver seamless, high - quality care to patients before, during, and after their hospital stay.
Some of the key surgeons at NewYork - Presbyterian Queens include:
- Benjamin Enoch Lee, M.D.: Associate attending cardiothoracic surgeon and associate professor of clinical cardiothoracic surgery. His specialties include surgery, and he is affiliated with NewYork - Presbyterian Queens and NewYork - Presbyterian Hospital.
- Oliver S. Chow, M.D.: Assistant attending cardiothoracic surgeon and assistant professor of clinical cardiothoracic surgery. His specialty is thoracic surgery (cardiothoracic vascular surgery), and he is affiliated with NewYork - Presbyterian Hospital.
NewYork - Presbyterian/Columbia University Irving Medical Center
Dr. Lyall A. Gorenstein, who practices at NewYork - Presbyterian/Columbia University Irving Medical Center, specializes in thoracic surgery, with a special focus on minimally invasive thoracic surgery, hyperhidrosis - palmar, and pectus excavatum. He is board - certified in surgery and thoracic surgery. Dr. Gorenstein has in - depth knowledge of both the Nuss procedure and the modified Ravitch repair, and can provide patients with detailed consultations and personalized treatment plans. The hospital's thoracic surgery program is well - known for its high - quality care and advanced surgical techniques, and patients can expect to receive comprehensive pre - and post - operative care.
Choosing the Right Hospital and Surgeon
When choosing a hospital and surgeon for adult pectus excavatum surgery, several factors should be considered:
- Surgeon's experience: Look for surgeons who have performed a significant number of pectus excavatum surgeries. Experience can greatly impact the success rate of the procedure and the patient's recovery.
- Hospital facilities: Advanced facilities, such as state - of - the - art operating rooms and intensive care units, can contribute to better surgical outcomes and patient safety.
- Multidisciplinary approach: Hospitals that offer a multidisciplinary team of specialists, including cardiologists, pulmonologists, and physical therapists, can provide more comprehensive care throughout the treatment process.
- Patient reviews and testimonials: Reading reviews from other patients who have undergone pectus excavatum surgery at the hospital can give you an idea of the quality of care and patient satisfaction.
- Cost and insurance: Consider the cost of the surgery and whether your insurance will cover it. Make sure to discuss insurance coverage with the hospital's financial department before scheduling the procedure.
Pre - operative and Post - operative Care
Pre - operative Care
Before the surgery, a complete medical exam and medical tests are usually required. These may include 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. Patients should inform the surgeon or nurse about any medicines they are taking, including drugs, herbs, vitamins, or other supplements, as well as any allergies they may have to medicine, latex, tape, or skin cleanser. About 7 days before surgery, patients may be asked to stop taking aspirin, ibuprofen, naproxen, warfarin, and any other blood - thinning drugs. On the day of surgery, patients are usually asked not to drink or eat anything after midnight the night before, and they should give themselves any drugs the surgeon told them to give with a small sip of water. They should also arrive at the hospital on time, and the surgeon will make sure the patient has no signs of illness before surgery.
Post - operative Care
After the surgery, the recovery period varies depending on the person's age and the amount of chest depression. 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. Pain is common after the surgery, and for the first few days, patients may receive strong pain medicine in the vein (through an IV) or through a catheter placed in the spine (an epidural). After that, pain is usually managed with medicines taken by mouth. Patients may have tubes in the chest around the surgical cuts to drain extra fluid, and these tubes will remain in place until they stop draining, usually after a few days. The day after surgery, patients are encouraged to sit up, take deep breaths, and get out of bed and walk to aid in healing.
Conclusion
Adult pectus excavatum can have significant physical and psychological impacts on patients. However, with the availability of advanced surgical treatments in New York City hospitals such as NYU Langone Health, NewYork - Presbyterian Queens, and NewYork - Presbyterian/Columbia University Irving Medical Center, patients have access to high - quality care and experienced surgeons. When considering surgery, it is essential to carefully choose the hospital and surgeon based on factors such as experience, facilities, and the multidisciplinary approach. Additionally, proper pre - operative and post - operative care is crucial for a successful recovery. By taking these steps, patients can improve their quality of life and regain confidence.
If you or someone you know is considering adult pectus excavatum surgery in New York City, we encourage you to do further research, consult with the hospitals mentioned above, and speak to their specialists to get more information. Share this article with others who may be interested in learning about this topic and exploring treatment options.
