Introduction to Mild Pectus Excavatum
Pectus excavatum is a relatively common congenital deformity where the chest wall is sunken in, creating a caved - in appearance. Mild pectus excavatum may not cause significant physical symptoms, but it can still have an impact on a patient's self - esteem, especially in children and teenagers. Approximately 40% of people with pectus excavatum have one or more family members with the defect, and it occurs more often in males than in females, according to Columbia Surgery.
Although its causes are not completely understood, the condition is believed to arise from excessive growth of the cartilage connecting the ribs to the breastbone, which pulls the sternum inward. Mild cases may go unnoticed, but as the individual grows, especially during puberty, the deformity can become more pronounced.
Symptoms of Mild Pectus Excavatum
- Appearance: The most obvious symptom is the sunken appearance of the chest. In mild cases, this may be a subtle depression that is only noticeable under certain conditions, such as when the person is lying flat or wearing tight - fitting clothing.
- Psychological impact: Even though there may be no major physical symptoms, patients with mild pectus excavatum can experience self - consciousness, especially in social or physical activity settings where the chest is exposed. This can lead to withdrawal from sports or other activities and difficult peer interactions, as highlighted by Columbia Surgery.
Diagnosis of Mild Pectus Excavatum
Doctors use multiple tools to diagnose pectus excavatum and gauge its extent. These include:
- Visual examination: A simple yet important initial step where the doctor visually inspects the chest for any signs of depression.
- Auscultation: Analysis of sounds of the heart and chest to detect the condition's effect on heart and lung function.
- Electrocardiogram (ECG): To check the electrical activity of the heart and detect any irregularities that may be related to the chest deformity.
- Echocardiogram: A non - invasive test that takes a picture of the heart with sound waves to assess its 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 evaluate lung function.
- Chest X - ray: Provides a basic view of the chest structure and can show the extent of the pectus excavatum.
- CT - scan: A more detailed imaging test that can accurately measure the degree of depression and calculate the Haller index. A Haller index greater than 3.25 is generally considered severe, while in mild cases, the index is lower.
Importance of Choosing the Right Hospital
Selecting the right hospital for the treatment of mild pectus excavatum is crucial for several reasons. The quality of medical care, the expertise of the medical staff, and the availability of advanced treatment options can all have a significant impact on the outcome of the treatment and the patient's overall experience.
Quality of Medical Care
A high - quality hospital has strict standards for patient care, including proper diagnosis, appropriate treatment planning, and thorough follow - up. This ensures that patients receive the best possible care throughout their treatment journey. For example, hospitals with a reputation for excellence are more likely to have a multidisciplinary team of doctors, including cardiologists, pulmonologists, and surgeons, who can work together to provide comprehensive care.
Expertise of Medical Staff
The experience and expertise of the medical staff play a vital role in the treatment of mild pectus excavatum. Surgeons who specialize in chest wall deformities have a better understanding of the complex anatomy and can perform the necessary procedures with greater precision. Additionally, experienced doctors are more likely to be familiar with the latest treatment techniques and research findings, which can lead to better treatment outcomes.
Availability of Advanced Treatment Options
Top hospitals often have access to the latest and most advanced treatment options for mild pectus excavatum. These may include minimally invasive surgical procedures, such as the Nuss procedure, which have several advantages over traditional open surgeries, including smaller incisions, reduced scarring, and faster recovery times. Some hospitals may also offer non - surgical treatment options, such as vacuum bell therapy, for patients who do not wish to undergo surgery or are not suitable candidates.
Top Three Hospitals for Mild Pectus Excavatum in New York City
1. New York - Presbyterian Hospital - Columbia and Cornell
Overview
New York - Presbyterian Hospital - Columbia and Cornell is one of the leading hospitals in New York City. It is nationally ranked in 14 adult specialties and 10 pediatric specialties, according to U.S. News Best Hospitals. The hospital is part of Columbia University Irving Medical Center and has a long - standing reputation for providing high - quality medical care.
Expertise in Pectus Excavatum Treatment
The hospital's surgical team has extensive experience in treating pectus excavatum. They offer both surgical and non - surgical treatment options based on the patient's specific condition. For surgical cases, the team is proficient in performing procedures such as the Nuss procedure and the modified Ravitch repair. The Nuss procedure is a minimally invasive technique that involves inserting a convex bar underneath the sternum to push it outward. The modified Ravitch repair, on the other hand, may be used in more complex cases and involves removing small pieces of deformed chest cartilage and repositioning the ribs and sternum. Additionally, the hospital has a multidisciplinary approach, with cardiologists and pulmonologists involved in the pre - operative and post - operative care to ensure the best possible outcomes for patients.
Patient Experience
Patients at New York - Presbyterian Hospital - Columbia and Cornell benefit from the hospital's commitment to patient - centered care. The medical staff takes the time to explain the treatment options in detail and address any concerns that patients or their families may have. The hospital also has a supportive environment, with state - of - the - art facilities and a focus on ensuring patient comfort during their stay.
2. Mount Sinai Hospital
Overview
Mount Sinai Hospital is another top - ranked hospital in New York City. It is nationally ranked in 12 adult specialties and 4 pediatric specialties, as reported by U.S. News Best Hospitals. The hospital is known for its innovative research and cutting - edge medical treatments.
Expertise in Pectus Excavatum Treatment
Mount Sinai Hospital's team of doctors is well - versed in treating pectus excavatum. They offer a range of treatment options tailored to the individual needs of each patient. In addition to surgical procedures, the hospital also has a program for non - surgical management of mild pectus excavatum. The hospital's surgeons are highly skilled in performing the necessary surgeries, with a focus on minimizing complications and achieving excellent cosmetic and functional results. For example, during the pectus excavatum repair surgery, they are meticulous in ensuring that the breastbone is repositioned correctly and that the chest wall regains its normal shape.
Patient Experience
Patients at Mount Sinai Hospital receive personalized care from a team of dedicated healthcare professionals. The hospital provides comprehensive pre - operative and post - operative support, including pain management, physical therapy, and emotional support. The medical staff is trained to communicate effectively with patients and their families, ensuring that they are well - informed throughout the treatment process.
3. NYU Langone Hospitals
Overview
NYU Langone Hospitals is a highly regarded medical institution in New York City. It is nationally ranked in 13 adult specialties and 3 pediatric specialties, according to U.S. News Best Hospitals. The hospital is known for its comprehensive approach to medical care and its focus on research and education.
Expertise in Pectus Excavatum Treatment
NYU Langone's team of doctors who treat pectus excavatum is dedicated to providing the most advanced, personalized care. They offer a variety of treatment options, including minimally invasive surgeries and non - surgical approaches. The hospital's surgeons have extensive experience in performing the Nuss procedure, which has become a popular choice for treating pectus excavatum due to its less invasive nature. The medical team also conducts thorough evaluations of each patient to determine the most appropriate treatment plan, taking into account factors such as the severity of the deformity, the patient's age, and overall health.
Patient Experience
Patients at NYU Langone Hospitals benefit from the hospital's patient - centered approach. The medical staff takes the time to understand the unique needs and concerns of each patient and provides individualized care. The hospital also offers a range of support services, such as nutritional counseling and psychological support, to help patients throughout their treatment journey. Additionally, the hospital's facilities are modern and well - equipped, providing a comfortable and safe environment for patients.
Comparison of the Three Hospitals
| Hospital | National Rankings | Treatment Options | Multidisciplinary Approach | Patient - Centered Care |
|---|---|---|---|---|
| New York - Presbyterian Hospital - Columbia and Cornell | 14 adult specialties and 10 pediatric specialties | Surgical (Nuss procedure, modified Ravitch repair), non - surgical | Yes, with cardiologists and pulmonologists involved | High, detailed explanation of treatment options, focus on comfort |
| Mount Sinai Hospital | 12 adult specialties and 4 pediatric specialties | Surgical and non - surgical management | Yes, comprehensive care | High, personalized care, pre - and post - operative support |
| NYU Langone Hospitals | 13 adult specialties and 3 pediatric specialties | Minimally invasive surgeries (Nuss procedure), non - surgical | Yes, thorough patient evaluations | High, individualized care, support services |
Treatment Options for Mild Pectus Excavatum
Surgical Options
Nuss Procedure
The Nuss procedure is a minimally invasive surgical technique for treating pectus excavatum. It is performed under general anesthesia and involves creating a horizontal passage underneath the sternum through two small incisions in the side of the chest. A convex bar known as the Lorenz pectus bar is specially shaped to fit the individual’s anatomy, 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 then removed as an outpatient procedure. This procedure has several advantages, including smaller incisions, reduced scarring, less blood loss, and a faster recovery time compared to traditional open surgeries.
Modified Ravitch Repair
The modified Ravitch repair is a more traditional surgical approach. It is performed under general anesthesia and involves making a horizontal incision. The technique involves removing small pieces of deformed chest cartilage and repositioning the protruding ribs and sternum. To support the repaired chest architecture, titanium bars are secured to the ribs and sternum. In the past, the supports needed to be removed after several years, but current bars can remain permanently in place, avoiding the need for a second operation. This procedure may be used in more complex cases of pectus excavatum.
Non - Surgical Options
Vacuum Bell Therapy
Vacuum bell therapy is a non - surgical treatment option for mild pectus excavatum. It involves using a vacuum bell device that is placed over the chest. The device creates a vacuum, which gently pulls the chest wall outward. Patients are typically advised to use the vacuum bell for a certain period of time each day. Studies have shown that a significant number of patients can see improvements in the appearance of their chest with this therapy. Approximately 80% of patients may see an elevation greater than 1 cm within 3 months, and around 20% may see complete correction within 6 months, and about 13.5% may see complete correction within 18 months, according to Nationwide Children's Hospital.
Exercises and Stretches
Exercises and stretches can also be beneficial for patients with mild pectus excavatum. These may include chest - opening exercises, such as shoulder rolls, chest flyes, and yoga poses like the cobra pose. These exercises can help strengthen the muscles around the chest and improve posture, which may in turn have a positive impact on the appearance of the chest. However, it should be noted that exercises alone may not completely correct the pectus excavatum but can be used as a complementary treatment option.
Pre - operative and Post - operative Care
Pre - operative Care
Before undergoing surgery for pectus excavatum, patients need to undergo a series of evaluations and preparations. This includes a complete medical exam and medical tests. The surgeon will typically order an electrocardiogram (ECG) and possibly an echocardiogram to check the heart function, pulmonary function tests to assess breathing, and a CT scan or MRI of the chest to get a detailed view of the chest structure. Patients also need to inform the surgeon or nurse about any medications they are taking, including drugs, herbs, vitamins, or any other supplements bought without a prescription, 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 to take any drugs the surgeon has instructed with a small sip of water. They should arrive at the hospital on time, and the surgeon will make sure the patient has no signs of illness before proceeding with the surgery.
Post - operative Care
After surgery, patients typically stay in the hospital for 3 to 7 days, depending on how well the recovery is going. Pain is common after the surgery, and for the first few days, patients may receive strong pain medicine through an IV or an epidural. After that, pain is usually managed with oral medications. Patients may have tubes in the chest around the surgical cuts to drain extra fluid, which are removed once 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 the healing process. At first, patients should avoid bending, twisting, or rolling from side to side, and activities will be gradually increased. When the patient 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 any instructions for caring for themselves at home.
Conclusion
Choosing the right hospital for the treatment of mild pectus excavatum is a critical decision. New York - Presbyterian Hospital - Columbia and Cornell, Mount Sinai Hospital, and NYU Langone Hospitals are all top - notch institutions in New York City that offer high - quality care, experienced medical staff, and a variety of treatment options. Each hospital has its own strengths, but they all share a commitment to providing the best possible outcomes for patients with pectus excavatum.
Whether you choose surgical or non - surgical treatment, it is important to have a comprehensive understanding of the available options and to work closely with your medical team. The pre - operative and post - operative care also play a vital role in the success of the treatment and the patient's overall recovery.
If you or someone you know is suffering from mild pectus excavatum, we encourage you to reach out to one of these top hospitals for a consultation. Take the first step towards improving your health and quality of life today!
