Understanding Pectus Excavatum
Pectus excavatum, commonly referred to as funnel chest or sunken chest, is a prevalent chest wall deformity. It causes some of the ribs to grow inwards, resulting in a caved - in appearance of the chest. While the condition affects about one in every 300 to 400 children, it can occur in people of all ages. It often runs in families and is more frequently found in boys. In many cases, it's detected as early as 2 to 3 years old, but symptoms may become more evident or worsen during puberty, around ages 9 – 12 in girls and ages 11 – 15 in boys. After a child has finished growing, the condition usually stabilizes and doesn't worsen.
Causes and Symptoms
The abnormal growth, rotation, and lengthening of cartilage in the ribs lead to the sternum, or breastbone, becoming sunken or concave. This can also cause the lower ribs to flare out. Some of the common symptoms associated with pectus excavatum include:
- Shortness of breath, especially during physical exertion
- Chest pain that can range from mild discomfort to severe pain
- Fainting spells, which may be a sign of more severe impairment
- Heart palpitations or other cardiac irregularities, indicating potential heart - related issues
Beyond the physical symptoms, the visible deformity can lead to body - image issues and depression, especially in children, adolescents, and young adults. They may feel self - conscious about their appearance and struggle to fit in with their peers.
Diagnosis
To diagnose pectus excavatum, a physician will conduct a comprehensive physical exam and evaluation. This typically includes a series of imaging and cardiopulmonary function tests:
| Test | Description |
|---|---|
| Computed Tomography (CT) scan | Produces detailed cross - sectional images of the chest, helping to assess the severity of the deformity and any internal structural changes |
| Magnetic Resonance Imaging (MRI) scan | Provides high - quality images of soft tissues and bones, useful for a more in - depth view of the chest wall and its surrounding structures |
| Echocardiogram | A sonogram of the heart that shows real - time images of how well the heart and its valves are working, and how the chest wall may be affecting heart function |
| Electrocardiogram (EKG) | Measures the electrical activity of the heart to detect any irregularities in rhythm |
| Lung function tests | Measure the amount of air the lungs can hold and how quickly the lungs can empty, helping to evaluate the impact on respiratory function |
| Exercise assessments | Monitor how well the heart and lungs function during physical activity, such as cycling or running on a treadmill |
| Evaluation for connective tissue disorders | Checks for associated conditions that may contribute to the development of pectus excavatum |
A scale called the Haller index is used to assess the severity of pectus excavatum. It uses a ratio of the thoracic (chest) width and height, measured from CT or MRI scans, to rate the condition as mild, moderate, severe, or extreme.
Treatment Options for Pectus Excavatum
Non - surgical Treatments
Most mild cases of pectus excavatum do not require surgery. Physical therapy and specific exercises can be helpful in improving symptoms. These exercises focus on strengthening the chest and back muscles, improving posture, and increasing the degree to which the chest can expand. For instance, exercises like chest stretches, back extensions, and wall push - ups can be beneficial. Some hospitals may also offer the “ vacuum bell ” treatment for less severe cases, especially in younger patients with a soft and pliable chest. The vacuum bell is a large suction cup that creates a vacuum seal on the chest wall, gradually lifting the sternum over time. However, about 25% of patients may experience a recurrence and need additional treatment.
Surgical Treatments
For moderate to extreme cases, surgery may be recommended. There are two primary surgical procedures:
Modified Ravitch Procedure
During this procedure, the surgeon makes an incision across the chest at the level of the indent. They then remove the rib cartilage above and below the sternum and break the sternum. A rod is placed beneath the sternum before sewing it back together. This procedure typically takes about four hours to perform. The rod will be removed in a later surgery after the condition has been fully corrected, usually after 6 to 12 months. It is especially well - suited for patients who do not wish to have a bar in place for more than one year and those with highly asymmetric chest wall deformities or problematic lower rib flaring.
Nuss Procedure
This is a minimally invasive procedure. The surgeon makes two small incisions on either side of the chest and slides a customized bar in upside down between the heart and the breastbone before flipping the bar over. The procedure takes about one hour. The bar will be removed about three years after the initial surgery. The Nuss procedure has several advantages, including smaller incisions, reduced scarring, less blood loss, and a quicker return to regular activities compared to the modified Ravitch procedure. In recent years, surgeons have also introduced cryoblation during the Nuss procedure to manage pain. By freezing some of the nerves near the ribs and sternum before inserting the bar, postoperative pain can be greatly reduced, and the average hospital stay post - surgery has been reduced from one week to two to three days.
Top 5 Hospitals in Albany for Mild Pectus Excavatum Correction
Hospital 1: [Hospital Name 1]
[Hospital Name 1] in Albany has a well - established pediatric surgery department with experienced surgeons who specialize in pectus excavatum correction. They offer a comprehensive range of treatments, including both non - surgical and surgical options. The hospital uses state - of - the - art diagnostic tools, such as the latest CT and MRI scanners, to accurately assess the severity of pectus excavatum. Their surgical team is proficient in performing both the modified Ravitch procedure and the Nuss procedure. The hospital also provides extensive pre - and post - operative care, including physical therapy and psychological support for patients dealing with body - image issues. For non - surgical cases, they have a team of physical therapists who design personalized exercise programs for patients.
Hospital 2: [Hospital Name 2]
[Hospital Name 2] is known for its innovative approach to pectus excavatum treatment. They have been at the forefront of adopting new techniques, such as the use of the vacuum bell for mild cases. The hospital's surgical team has a high success rate in performing the Nuss procedure, with a focus on minimizing pain and reducing the hospital stay. They use advanced pain management techniques, including cryoblation, to ensure patients are as comfortable as possible during the recovery process. Additionally, the hospital has a dedicated follow - up program to monitor patients' progress after surgery, including regular check - ups and imaging tests to ensure proper healing and the absence of complications.
Hospital 3: [Hospital Name 3]
At [Hospital Name 3], the medical staff is highly experienced in treating pectus excavatum in patients of all ages. They have a multi - disciplinary team that includes cardiologists, pulmonologists, and physical therapists, who work together to provide holistic care. The hospital offers both the modified Ravitch and Nuss procedures, with a detailed evaluation process to determine the most suitable treatment for each patient. Their surgeons pay close attention to the cosmetic outcome of the surgery, ensuring that patients not only experience functional improvements but also have an improved appearance. After surgery, patients receive comprehensive rehabilitation programs to help them regain strength and mobility quickly.
Hospital 4: [Hospital Name 4]
[Hospital Name 4] has a long - standing reputation for excellence in chest wall surgery. Their surgical techniques are constantly evolving, and they are committed to using the latest evidence - based practices. The hospital provides a patient - centered approach, with a focus on educating patients and their families about pectus excavatum and the available treatment options. They have a dedicated pectus excavatum clinic where patients can receive in - depth consultations and evaluations. For surgical cases, the hospital offers a seamless experience, from pre - operative preparations to post - operative care, with a particular emphasis on pain management and minimizing the risk of complications.
Hospital 5: [Hospital Name 5]
[Hospital Name 5] is a leading medical institution in Albany for pectus excavatum correction. They have a high - volume pectus excavatum practice, which means their surgeons have extensive experience in dealing with various cases. The hospital offers a wide range of surgical and non - surgical treatment options, tailored to the individual needs of each patient. They use advanced imaging technologies to accurately plan surgeries, ensuring the best possible outcomes. In addition to surgical expertise, the hospital provides emotional support to patients and their families throughout the treatment process, recognizing the psychological impact of pectus excavatum.
Recovery and Follow - up
Recovery after pectus excavatum surgery varies depending on the type of procedure performed. For both the modified Ravitch and Nuss procedures, patients can expect to stay in the hospital for a few days to a week. After surgery, pain management is a crucial aspect of recovery. Patients may receive strong pain medicine in the vein (through an IV) or through a catheter placed in the spine (an epidural) in the first few days, followed by oral pain medications.
Physical activity restrictions are also an important part of the recovery process. Patients are usually advised to avoid activities that involve twisting of the torso, such as driving, for about six weeks. Heavy activities should be restricted for about nine months to a year. Regular follow - up visits with the surgeon are essential to monitor progress and determine when the bar or rod can be removed. These visits typically include physical examinations, imaging tests, and assessments of heart and lung function.
Conclusion
Pectus excavatum, though a common chest wall deformity, can have a significant impact on a patient's physical and psychological well - being. Fortunately, there are effective treatment options available, both non - surgical and surgical. In Albany, the top 5 hospitals mentioned above offer a wide range of techniques and comprehensive care for patients with mild pectus excavatum. Whether it's through physical therapy, the use of the vacuum bell, or surgical procedures like the modified Ravitch or Nuss procedure, these hospitals are equipped to provide the best possible outcomes for their patients.
If you or someone you know is dealing with mild pectus excavatum in Albany, we encourage you to click to get more detailed information about these top 5 hospitals and the different techniques they offer. Take the first step towards a better quality of life and improved chest appearance by exploring these excellent treatment options.
