Introduction to Pectus Excavatum
Pectus excavatum is a congenital deformity where the chest wall caves in, giving a sunken appearance. It occurs more often in males and around 40% of patients have family members with the same defect. The exact cause is not fully understood, but 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 affect lung capacity, leading to fatigue, shortness of breath, chest pain, and a fast heartbeat. It may also cause a heart murmur due to the proximity of the sternum and the pulmonary artery. In addition to the physical symptoms, it can have negative psychosocial effects, especially on children and teenagers who may feel self - conscious about their appearance and avoid activities that expose the chest.
Multiple tools are used to diagnose pectus excavatum, including visual examination, auscultation, electrocardiogram (ECG), echocardiogram, pulmonary function testing, chest X - ray, CT - scan, and calculating the Haller index. A Haller index greater than 3.25 is generally considered severe.
Diagnostic Tools for Pectus Excavatum
| Diagnostic Tool | Description |
|---|---|
| Visual Examination | Directly observing the chest for the characteristic sunken appearance. |
| Auscultation | Listening to the sounds of the heart and chest to detect the condition's effect on heart and lung function. |
| Electrocardiogram (ECG) | Recording the electrical activity of the heart to check for any abnormalities. |
| Echocardiogram | Using sound waves to create a picture of the heart, a non - invasive test. |
| Pulmonary Function Testing | Measuring the amount of air breathed over a period of time to assess lung function. |
| Chest X - ray | Taking an image of the chest to show the structure of the bones and lungs. |
| CT - scan | Providing detailed cross - sectional images of the chest to accurately assess the condition. |
| 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 value greater than 3.25 indicates severity. |
Top 3 Hospitals for Pectus Excavatum Surgery in New York City
1. New York - Presbyterian Hospital - Columbia and Cornell
New York - Presbyterian Hospital - Columbia and Cornell is one of the leading institutions for pectus excavatum surgery in New York City. It is nationally ranked in 14 adult specialties and 10 pediatric specialties, and high - performing in 1 specialty and 20 procedures/conditions.
The hospital's thoracic surgery team at Columbia University's surgical lung & chest care program provides up - to - date options for all chest conditions, including pectus excavatum. They pride themselves on being consistently named one of New York’s top hospitals and one of the top ten medical centers in the nation. Their team of experts is dedicated to using the latest breakthroughs in the field and providing individual respect and clear communication to patients.
Dr. Lyall A. Gorenstein, affiliated with New York - Presbyterian / Columbia University Irving Medical Center, specializes in thoracic surgery with a special focus on minimally invasive thoracic surgery and pectus excavatum. He graduated from Canada in 1983 and has completed extensive training at various renowned institutions. He is board - certified in surgery and thoracic surgery.
The hospital offers advanced surgical techniques for pectus excavatum repair, such as the minimally invasive Nuss procedure and the modified Ravitch repair. The Nuss procedure uses video - assisted thoracoscopic surgery to insert a convex bar under the sternum to lift it and reshape the chest. The modified Ravitch repair involves removing small pieces of deformed chest cartilage and repositioning the ribs and sternum, with titanium bars used to support the repaired chest architecture.
2. Mount Sinai Hospital
Mount Sinai Hospital is another top - tier hospital for pectus excavatum surgery in New York. It is nationally ranked in 12 adult specialties and 4 pediatric specialties and high - performing in 20 procedures/conditions.
The hospital has a team of experienced thoracic surgeons who are well - versed in treating pectus excavatum. Dr. Andrea Wolf, an associate professor of thoracic surgery at Mount Sinai, specializes in general thoracic surgery and has expertise in robotic and minimally - invasive techniques, including video - assisted thoracic (VATS) and laparoscopic surgery for various chest conditions, including pectus excavatum. She has received numerous awards for her work in mesothelioma and lung cancer research and has extensive experience in providing comprehensive, multidisciplinary clinical care.
Mount Sinai offers both open and closed surgical options for pectus excavatum repair. Open surgery involves making a cut across the front of the chest, removing deformed cartilage, and repositioning the breastbone. Closed or minimally invasive surgery, often used for children, makes two small incisions on the sides of the chest and inserts a curved steel bar under the breastbone to lift it.
3. NYU Langone Hospitals
NYU Langone Hospitals are highly regarded for their expertise in pectus excavatum surgery. They are nationally ranked in 13 adult specialties and 3 pediatric specialties and high - performing in 1 specialty and 21 procedures/conditions.
NYU Langone's team of doctors is dedicated to providing the most advanced, personalized care for patients with pectus excavatum. Their physicians are at the forefront of medical research and are constantly exploring new treatment options to improve patient outcomes.
The hospital offers a comprehensive approach to pectus excavatum treatment, from diagnosis to postoperative care. They use state - of - the - art diagnostic tools to accurately assess the severity of the condition and then tailor the surgical treatment to each patient's specific needs. The surgical techniques available at NYU Langone are in line with the latest industry standards, ensuring the best possible results for patients.
Top 5 Hospitals for Pectus Excavatum Surgery in New York City
4. North Shore University Hospital at Northwell Health
North Shore University Hospital at Northwell Health is nationally ranked in 9 adult specialties and high - performing in 15 procedures/conditions. It has a well - established thoracic surgery department that is equipped to handle pectus excavatum cases.
The hospital's surgeons are trained in the latest surgical techniques, including minimally invasive approaches, which offer less pain, shorter hospital stays, and faster recovery times for patients. They work closely with a multidisciplinary team of specialists, such as pulmonologists, cardiologists, and physical therapists, to ensure comprehensive care for patients undergoing pectus excavatum surgery.
North Shore University Hospital also invests in research and development to improve the treatment of pectus excavatum. This allows them to stay updated with the latest advancements in the field and provide patients with the most effective treatment options.
5. Lenox Hill Hospital at Northwell Health
Lenox Hill Hospital at Northwell Health is nationally ranked in 10 adult specialties and high - performing in 1 specialty and 16 procedures/conditions. It has a reputation for providing high - quality surgical care for various conditions, including pectus excavatum.
Dr. Lawrence Bodenstein, a pediatric surgeon affiliated with Lenox Hill Hospital, has experience in treating pediatric patients with pectus excavatum. His expertise in pediatric surgery ensures that young patients receive specialized care that takes into account their unique physiological and developmental needs.
The hospital offers a patient - centered approach to pectus excavatum surgery. They focus on providing a comfortable and supportive environment for patients and their families throughout the treatment process. From pre - operative counseling to post - operative rehabilitation, Lenox Hill Hospital ensures that patients receive comprehensive care at every stage.
Factors to Consider When Choosing a Hospital for Pectus Excavatum Surgery
1. Hospital Reputation
A hospital's reputation is a crucial factor to consider. Hospitals that are nationally ranked and have a long - standing history of providing high - quality care for pectus excavatum are more likely to have experienced surgeons, advanced facilities, and better patient outcomes. For example, New York - Presbyterian Hospital - Columbia and Cornell and Mount Sinai Hospital are well - known for their excellence in thoracic surgery and overall medical care.
2. Surgeon Experience
The experience of the surgeon performing the pectus excavatum surgery is vital. Surgeons with extensive experience in performing the specific surgical techniques for pectus excavatum, such as the Nuss procedure or the modified Ravitch repair, are more likely to achieve successful outcomes. Look for surgeons who are board - certified in thoracic surgery and have a track record of performing a high volume of pectus excavatum surgeries.
3. Available Treatment Options
It is important to choose a hospital that offers a variety of treatment options for pectus excavatum. Different patients may have different needs and preferences, and a hospital that provides both open and minimally invasive surgical options can tailor the treatment to each patient's specific situation. For instance, younger patients may be better candidates for minimally invasive procedures, while more severe cases may require open surgery.
4. Multidisciplinary Care
Pectus excavatum treatment often requires a multidisciplinary approach. A hospital that has a team of specialists, including pulmonologists, cardiologists, physical therapists, and psychologists, can provide comprehensive care for patients. This ensures that all aspects of the patient's health, both physical and psychological, are addressed during the treatment process.
5. Location and Accessibility
The location of the hospital and its accessibility can also be important factors, especially for patients who may need to make multiple visits for pre - operative evaluations, surgery, and post - operative follow - up. Choosing a hospital that is conveniently located can make the treatment process more manageable for patients and their families.
Pre - operative and Post - operative Care for Pectus Excavatum Surgery
Pre - operative Care
Before pectus excavatum surgery, patients will undergo a series of evaluations and preparations. A complete medical exam and various medical tests are necessary. These may include an electrocardiogram (ECG) and possibly an echocardiogram to assess heart function, pulmonary function tests to check for breathing problems, and a CT scan or MRI of the chest to get a detailed view of the chest structure.
Patients should inform the surgeon or nurse about all the medicines they are taking, including over - the - counter drugs, herbs, vitamins, and supplements. They also need to disclose any allergies they may have to medicine, latex, tape, or skin cleanser. About 7 days before surgery, patients may be asked to stop taking blood - thinning drugs such as aspirin, ibuprofen, naproxen, and warfarin. On the day of surgery, patients will likely be asked not to eat or drink anything after midnight the night before, and they should take any drugs as instructed by the surgeon with a small sip of water.
Post - operative Care
After pectus excavatum surgery, patients usually stay in the hospital for 3 to 7 days, depending on the recovery progress. Pain is common after the surgery, and patients may receive strong pain medicine through an IV or an epidural in the first few days, followed by oral pain medicine. There may be tubes in the chest to drain extra fluid, which will be removed when the drainage stops, 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. At first, patients should avoid bending, twisting, or rolling from side to side, and activities will gradually be increased. When patients can walk without help, they are usually ready to go home. Before leaving the hospital, patients will receive a prescription for pain medicine, and they should follow all the instructions for caring for themselves at home.
Conclusion
Choosing the right hospital for pectus excavatum surgery is a critical decision that can have a significant impact on the patient's treatment outcome and overall well - being. The top 3 and top 5 hospitals in New York City, including New York - Presbyterian Hospital - Columbia and Cornell, Mount Sinai Hospital, NYU Langone Hospitals, North Shore University Hospital at Northwell Health, and Lenox Hill Hospital at Northwell Health, offer high - quality surgical care, experienced surgeons, and a comprehensive approach to pectus excavatum treatment.
Patients and their families should carefully consider factors such as hospital reputation, surgeon experience, available treatment options, multidisciplinary care, and location when making their decision. By doing so, they can ensure that they receive the best possible care and achieve the most successful results from pectus excavatum surgery.
If you or someone you know is considering pectus excavatum surgery, we encourage you to research these hospitals further, schedule consultations with the surgeons, and gather as much information as possible. Take the first step towards improving your health and quality of life by making an informed decision about your treatment. Share this article with others who may be interested in learning more about pectus excavatum surgery in New York City.
