Introduction
Pectus excavatum is a relatively common congenital deformity where the chest wall is sunken in, creating a caved - in appearance. Severe cases can affect lung capacity, causing fatigue, shortness of breath, chest pain, and a fast heartbeat. For adults with pectus excavatum, surgery can be a viable option to improve both physical health and appearance. In New York City, several hospitals stand out for their expertise in adult pectus excavatum surgery. This article will present the top 5 hospitals in the city for this specific type of surgery, exploring their features, surgical options, and the benefits they offer to patients.
What is Pectus Excavatum?
Pectus excavatum occurs when several ribs and the sternum (breastbone) grow abnormally, pulling the sternum inward. It is often present at birth but may also develop during puberty. Approximately 40% of people with pectus excavatum have one or more family members with the defect, and it occurs more frequently in males than females. The causes of pectus excavatum are not fully understood, but it is believed to be related to excessive growth of the cartilage connecting the ribs to the breastbone.
Symptoms of pectus excavatum can range from mild to severe. In mild cases, individuals may have no symptoms during normal activities but may experience fatigue, shortness of breath, chest pain, and a fast heartbeat during rigorous exercise. Severe cases can significantly limit lung and heart capacity, leading to reduced physical performance and quality of life. Additionally, the condition can have negative psychosocial effects, especially in children and teenagers, who may feel self - conscious about their appearance and avoid activities that expose the chest.
Diagnosis of Pectus Excavatum
Multiple tools are used to diagnose pectus excavatum and gauge its extent:
- Visual examination of the chest: A doctor can often detect the characteristic sunken appearance of the chest during a physical examination.
- Auscultation: Analysis of the sounds of the heart and chest to detect the condition's effect on heart and lung function.
- Electrocardiogram (ECG, also called EKG): This test records the electrical activity of the heart and can help identify any heart - related issues associated with pectus excavatum.
- Echocardiogram: A non - invasive test that uses sound waves to take a picture of the heart, providing detailed information about 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, helping to assess lung function.
- Chest X - ray: Can provide a basic view of the chest structure.
- CT - scan: Offers a more detailed image of the chest, allowing for a more accurate assessment of the severity of the pectus excavatum.
- Haller index: Calculated from the CT scan, it measures the extent of pectus excavatum 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).
Surgical Options for Pectus Excavatum
There are two main surgical approaches for correcting 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. This procedure was originally developed for children but has also been used successfully in adults, with results comparable to the modified Ravitch procedure.
Modified Ravitch Repair
This procedure is also performed under general anesthesia. Using a horizontal incision, the surgeon removes small pieces of deformed chest cartilage and repositions 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.
The Top 5 Hospitals in New York City for Adult Pectus Excavatum Surgery
1. New York - Presbyterian Hospital - Columbia and Cornell
New York - Presbyterian Hospital - Columbia and Cornell is nationally ranked in 14 adult specialties and 10 pediatric specialties. The hospital's thoracic surgeons, in collaboration with Weill Cornell Medicine, provide the latest in surgical techniques and comprehensive care for patients with chest wall deformities such as pectus excavatum. Their team of experts is committed to using the most advanced minimally invasive diagnostic and surgical techniques, resulting in less pain and faster recovery for patients. The hospital offers both the Nuss procedure and the modified Ravitch repair, tailoring the treatment to the individual needs of each patient.
For example, Dr. Lyall A. Gorenstein, a thoracic surgeon affiliated with New York - Presbyterian/Columbia University Irving Medical Center, specializes in minimally invasive thoracic surgery, with a special focus on pectus excavatum. He graduated from Canada in 1983 and completed his training at multiple renowned institutions. He is board - certified in surgery and thoracic surgery, bringing a high level of expertise to the treatment of pectus excavatum patients.
2. Mount Sinai Hospital
Mount Sinai Hospital is nationally ranked in 12 adult specialties and 4 pediatric specialties. The hospital offers comprehensive care for patients with pectus excavatum, from diagnosis to surgical treatment and post - operative follow - up. Their surgical team is experienced in performing both open and minimally invasive surgeries for pectus excavatum repair. Open surgery involves making a cut across the front part of the chest, removing the deformed cartilage, and repositioning the breastbone. The minimally invasive approach, similar to the Nuss procedure, uses small incisions and a video camera to guide the placement of a bar under the sternum.
The hospital's focus on patient - centered care ensures that patients receive individualized treatment plans based on their specific condition and needs. They also have a dedicated team of nurses, respiratory therapists, and other healthcare professionals to support patients throughout their recovery process.
3. NYU Langone Hospitals
NYU Langone Hospitals are nationally ranked in 13 adult specialties and 3 pediatric specialties. The hospital's team of doctors who treat pectus excavatum is dedicated to providing the most advanced, personalized care. They offer state - of - the - art surgical options for pectus excavatum repair, including the latest advancements in minimally invasive techniques. NYU Langone's thoracic surgeons work closely with other specialists, such as cardiologists and pulmonologists, to ensure comprehensive care for patients with pectus excavatum.
Patients at NYU Langone can benefit from the hospital's extensive research and clinical trials, which may offer access to new and innovative treatments. The hospital also has a patient education program to help patients and their families understand the condition, the treatment options, and the recovery process.
4. North Shore University Hospital at Northwell Health
North Shore University Hospital at Northwell Health is nationally ranked in 9 adult specialties. The hospital has a specialized team of surgeons who are experienced in treating pectus excavatum. They offer a range of surgical options, including minimally invasive procedures, to correct the chest wall deformity. The hospital's commitment to using the latest technology and surgical techniques ensures optimal outcomes for patients.
In addition to surgical treatment, North Shore University Hospital provides comprehensive pre - operative and post - operative care. Their team of nurses, physical therapists, and social workers work together to support patients through every step of their treatment journey, helping them achieve a successful recovery.
5. Lenox Hill Hospital at Northwell Health
Lenox Hill Hospital at Northwell Health is nationally ranked in 10 adult specialties. The hospital offers high - quality care for patients with pectus excavatum. Their surgical team is trained in the latest techniques for pectus excavatum repair, including minimally invasive and open surgical approaches. The hospital also has a multi - disciplinary approach to patient care, involving cardiologists, pulmonologists, and other specialists to provide comprehensive treatment.
Lenox Hill Hospital focuses on patient comfort and satisfaction, providing a supportive environment for patients during their hospital stay. They also offer follow - up care to ensure that patients continue to recover well after surgery and maintain good long - term health.
Comparison of the Top 5 Hospitals
| Hospital Name | National Ranking (Adult Specialties) | Surgical Approaches Offered | Specialties and Collaborations | Patient - Centered Features |
|---|---|---|---|---|
| New York - Presbyterian Hospital - Columbia and Cornell | 14 | Nuss procedure, Modified Ravitch repair | Collaboration with Weill Cornell Medicine, experts in thoracic surgery | Individualized treatment plans, multi - disciplinary team |
| Mount Sinai Hospital | 12 | Open surgery, Minimally invasive surgery (similar to Nuss) | Comprehensive care from diagnosis to follow - up | Patient - centered care, dedicated support team |
| NYU Langone Hospitals | 13 | Advanced minimally invasive techniques | Collaboration with multiple specialists, access to research and clinical trials | Patient education program, personalized care |
| North Shore University Hospital at Northwell Health | 9 | Range of surgical options including minimally invasive | Specialized surgical team | Comprehensive pre - and post - operative care |
| Lenox Hill Hospital at Northwell Health | 10 | Minimally invasive and open surgical approaches | Multi - disciplinary approach to care | Focus on patient comfort and satisfaction, follow - up care |
Choosing the Right Hospital
When choosing a hospital for adult pectus excavatum surgery in New York City, several factors should be considered:
- Expertise of the surgical team: Look for hospitals with experienced surgeons who specialize in pectus excavatum surgery. Check their credentials, training, and the number of surgeries they have performed.
- Surgical options available: Ensure that the hospital offers the surgical approach that is most suitable for your condition, whether it is the Nuss procedure, modified Ravitch repair, or other advanced techniques.
- Comprehensive care: A good hospital should provide not only surgical treatment but also pre - operative evaluation, post - operative care, and follow - up services. This includes support from a multi - disciplinary team of specialists.
- Patient reviews and reputation: Read patient reviews and testimonials to get an idea of the hospital's quality of care, patient satisfaction, and outcomes.
- Research and innovation: Hospitals involved in research and clinical trials may offer access to new and improved treatments for pectus excavatum.
Recovery and Aftercare
Recovery after pectus excavatum repair varies depending on the individual's age, the severity of the condition, and the type of surgery performed. After surgery, most patients stay in the hospital for 3 to 5 days. Pain is common after the surgery, and patients may receive pain medication through an IV or an epidural in the initial days, followed by oral medications. Chest tubes may be placed to drain extra fluid, and these are usually removed after a few days.
Patients are encouraged to sit up, take deep breaths, and walk as soon as possible after surgery to aid in the healing process. They should avoid vigorous exercise for the first month and contact sports for three months after surgery. Full recovery may take several months, and regular follow - up appointments with the surgeon are necessary to monitor the healing process and ensure the long - term success of the surgery.
Conclusion
Adult pectus excavatum can have a significant impact on a person's physical health and quality of life. In New York City, the top 5 hospitals - 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 treatment for this condition. These hospitals have experienced surgical teams, a range of surgical options, and a commitment to providing comprehensive, patient - centered care. When considering surgery for pectus excavatum, it is important to carefully evaluate these hospitals based on their expertise, services, and patient outcomes.
If you or someone you know is dealing with pectus excavatum, we encourage you to explore the services offered by these top hospitals. Contact the hospitals directly to learn more about their surgical programs, meet with the surgeons, and get the information you need to make an informed decision. Share this article with others who may benefit from this valuable information about adult pectus excavatum surgery in New York City.
