Understanding Pectus Excavatum
Pectus excavatum is a congenital chest wall anomaly that has become a concern for many, especially in the medical field. It is a condition where the ribs and sternum grow inward, causing a sunken chest appearance. According to UPMC Children's, this condition can develop in the womb or after a baby is born. The prevalence of pectus excavatum varies, affecting anywhere from 1 in 300 to 1 in 1,000 births, and it is three to five times more common in males than females.
Symptoms of Pectus Excavatum
The symptoms of pectus excavatum can range from mild to severe. In mild cases, it might be barely noticeable, but in severe cases, it can cause significant problems. Some of the common symptoms include:
- Sunken Chest Appearance: This is the most obvious sign, where the sternum area appears sunken. The depression can be shallow or deep depending on the severity of the condition.
- Chest Pain: Patients may experience chest pain, which can be related to the abnormal bone and cartilage growth.
- Shortness of Breath: Severe cases of pectus excavatum can press on the heart and lungs, leading to shortness of breath, especially during exertion.
- Exercise Intolerance: Due to the compression on the heart and lungs, patients may find it difficult to tolerate exercise and may experience fatigue more quickly.
- Heart - related Symptoms: These can include heart palpitations, irregular heartbeat, and heart murmur.
- Rib Flare: The lower ribs may stick out, which is another physical manifestation of the condition.
Causes and Risk Factors
The exact cause of pectus excavatum is unknown. It can run in families, although there is no known genetic link to the condition. UPMC Children's mentions that abnormal development of the ribs or the cartilage that connects the sternum and ribs may also cause pectus excavatum. Other risk factors include:
- Abnormal Cartilage Development: An irregular development of the cartilage that connects the sternum and ribcage can contribute to the condition.
- Family History: If a family member has pectus excavatum, there is an increased risk of other family members developing it.
- Associated Health Conditions: It can occur in association with other health conditions such as Ehlers - Danlos syndrome, Marfan syndrome, Neurofibromatosis type 1, Noonan syndrome, Osteogenesis imperfecta, Poland syndrome, Rickets, Scoliosis, Spinal muscular atrophy, and Turner syndrome.
- Sex: Males are more likely to have pectus excavatum than females.
Diagnosis of Pectus Excavatum
Diagnosing pectus excavatum usually begins with a physical examination. As Mayo Clinic states, doctors can often diagnose pectus excavatum just by looking at the chest. However, additional tests may be required to determine the severity of the condition and to check for associated problems with the heart and lungs.
Diagnostic Tests
| Test Name | Description |
|---|---|
| Chest X - ray | This test can visualize the dip in the breastbone and often shows the heart being displaced into the left side of the chest. It is painless and takes only a few minutes to complete. |
| CT Scan or MRI | These tests may be used to help determine the severity of the pectus excavatum and whether the heart or lungs are being compressed. They take many images from a variety of angles to produce cross - sectional images of the body's internal structure. |
| Electrocardiogram | An electrocardiogram can show whether the heart's rhythm is normal or irregular and if the electrical signals that control the heartbeat are timed properly. It is painless and involves the placement of more than a dozen electrical leads attached to the body with a sticky adhesive. |
| Echocardiogram | An echocardiogram is a sonogram of the heart. It can show real - time images of how well the heart and its valves are working. The images are produced by transmitting sound waves via a wand pressed against the chest and also gives the doctor a look at how the chest wall may be affecting heart function and the flow of blood through the heart. |
| Lung Function Tests | These types of tests measure the amount of air your lungs can hold and how quickly you can empty your lungs. |
| Exercise Function Test | This test monitors how well your heart and lungs function while you exercise, usually on a bike or treadmill. |
| Genetic Tests | These tests can diagnose whether you have any genetic conditions related to pectus excavatum. |
Treatment Options for Pectus Excavatum
The treatment for pectus excavatum depends on the severity of the condition. For mild cases, non - surgical options may be sufficient, while more severe cases often require surgery.
Non - Surgical Options
- Physical Therapy: For minor cases of pectus excavatum, exercises focusing on the chest and core can help strengthen chest muscles and improve posture. Exercises such as deep breathing and push - ups can be beneficial. As Cook Children's suggests, compliance with the exercise program is important for optimal results.
- Vacuum Bell Device: This device is generally used in younger people with minor severity of pectus excavatum. The device, connected to a hand pump, is worn on the chest. Using the hand pump provides negative pressure to pull the chest forward. Daily use of the device over a span of months may improve minor cases of pectus excavatum.
Surgical Options
There are two main surgical procedures for pectus excavatum: the Nuss procedure and the Ravitch technique.
Nuss Procedure
The Nuss procedure is a minimally invasive thoracoscopic option. A surgeon makes two small cuts on either side of the chest, then inserts a curved metal bar underneath the sternum and attaches it to the ribs. Depending on the severity of the condition and the patient's age, the surgeon may use two or three bars. Over time, the steel bar fixes the shape of the chest. The bar typically remains in place for three years before the surgeon removes it during an outpatient procedure. Most patients are candidates for this procedure, but some very asymmetric deformities may require other approaches.
Ravitch Technique
This older procedure involves a much larger incision down the center of the chest. The surgeon removes the deformed cartilage attaching the ribs to the lower breastbone and then fixes the breastbone into a more normal position with surgical hardware, such as a metal strut or mesh supports. These supports are removed after 12 months. The Ravitch procedure is typically used in cases where pectus excavatum recurs.
Risk and Complications of Pectus Excavatum Surgery
Any surgery carries possible risks, and pectus excavatum surgery is no exception. UPMC Children's lists some of the risks and complications associated with pectus excavatum surgery:
- Bar Displacement: The metal bar inserted during surgery may become displaced, which can require additional intervention.
- Chronic Pain: Some patients may experience chronic pain after surgery, which can be difficult to manage.
- Heart or Lung Damage: There is a risk of damage to the heart or lungs during the surgical procedure.
- Hemothorax: This is the collection of blood between the lungs and chest wall.
- Pleural Effusion: It is the buildup of fluid between the lungs and the chest wall.
- Pneumothorax: A collapsed lung can occur as a complication of the surgery.
Recovery after Pectus Excavatum Surgery
Recovery after pectus excavatum surgery may take weeks to months. Patients typically stay in the hospital for at least a few days after the procedure. The following is a general recovery timeline:
- First Two Weeks: Patients should have limited mobility and may need to take pain medication. They may also need to stay home from work or school.
- Two to Six Weeks: Arm mobility can begin to increase, but patients still need to avoid strenuous activities.
- Six Weeks to Three Months: Patients can return to normal activities with the exception of sports and exercise.
- Three Months: They can return to non - contact sports like running.
- Six Months: Patients can return to full activity, including contact sports.
- Three Years: The bar is removed during an outpatient procedure.
Importance of Hospital Selection for Pectus Excavatum Surgery
Selecting the right hospital for mild - moderate pectus excavatum surgery is crucial. A high - quality hospital can provide better surgical outcomes, experienced medical staff, and comprehensive post - operative care. For example, Cleveland Clinic Children's is a nationally renowned resource for the management of pediatric chest wall deformities, including pectus excavatum. Over 98% of their pectus excavatum patients have been successfully treated with the minimally invasive Nuss procedure. CHOC's pectus treatment program brings together a multidisciplinary team of pediatric experts and uses leading - edge pectus procedures focused on reducing recovery time.
Criteria for Hospital Ranking in Albany for Pectus Excavatum Surgery
When ranking hospitals in Albany for mild - moderate pectus excavatum surgery, several factors can be considered:
- Success Rate: A hospital with a high success rate in performing pectus excavatum surgeries is more likely to provide good results. Success can be measured by the percentage of patients with improved symptoms and a normal - looking chest after surgery.
- Experience of Medical Staff: Surgeons and other medical staff with extensive experience in treating pectus excavatum are better equipped to handle any complications that may arise during surgery.
- Available Treatment Options: A good hospital should offer a variety of treatment options, both surgical and non - surgical, to meet the needs of different patients.
- Patient - centered Care: Hospitals that focus on patient - centered care provide a more comfortable and supportive environment for patients and their families. This can include services such as pain management, emotional support, and clear communication about the treatment process.
- Post - operative Rehabilitation: Comprehensive post - operative rehabilitation services can help patients recover more quickly and fully. This may include physical therapy, exercise programs, and follow - up appointments.
Top Hospitals in Albany for Mild - Moderate Pectus Excavatum Surgery
While the specific ranking list for Albany is the main focus, as of 2025, based on general industry standards and the criteria mentioned above, hospitals that are likely to be on the list may have the following characteristics:
Some hospitals may have a high - volume Nuss procedure practice, similar to Cleveland Clinic Children's, which contributes to better surgical outcomes. Others may have a strong multidisciplinary team, like CHOC, including cardiologists, pulmonologists, radiologists, surgeons, and pain management specialists, working together to provide comprehensive care. A hospital that invests in the latest technology and treatment techniques is also more likely to be well - ranked.
It's important for patients and their families to research and compare different hospitals in Albany. They can look at patient reviews, success rates, and the experience of the medical staff before making a decision.
Conclusion
Pectus excavatum is a common congenital chest wall anomaly that can have a significant impact on a patient's physical and emotional well - being. Early diagnosis and appropriate treatment are crucial for improving the condition. There are various treatment options available, both non - surgical and surgical, and the choice depends on the severity of the pectus excavatum. When it comes to surgery, selecting the right hospital is essential for achieving the best possible outcomes.
If you or your loved one is suffering from mild - moderate pectus excavatum and considering surgery, take the time to research the hospitals in Albany on the ranking list. Consult with medical professionals, read patient testimonials, and make an informed decision. You can also share this article with others who may be in need of this information to help them navigate their treatment journey.
