Sometimes you may have seen, or experienced, a hollow in the center of the chest. For some people, this is only a small part of the chest, while for others, it is very noticeable, as if the chest has sunk in. This is what doctors call `(Pectus Excavatum)`. Don't be too scared when you hear this name, this is a common condition. Today, we will talk about this in detail, very simply.
What is this chest pain, or (Pectus Excavatum)?
Simply put, `(Pectus Excavatum)` is a protrusion of the bone in the middle of our chest, that is, the sternum `(Sternum).` To be precise, this middle bone of the chest is bent inward. Due to this, you can see a clear sinking, or hollowing, of the chest. Usually, about four or five ribs on each side of the chest are connected to this.
This is also called a "sunken chest" or "funnel chest." This condition reduces the amount of space inside the chest. What happens then? There is not enough room for the heart and lungs to function properly.
`(Pectus Excavatum)` is a congenital condition. That means a person is born with this condition. But most of the time, it starts to become apparent in early adolescence, around the age of thirteen or fourteen. But don't worry, doctors can correct this condition with either minimally invasive surgery or traditional open surgery.
How common is this condition (Pectus Excavatum)?
This is the most common congenital abnormality of the chest wall. Roughly speaking, it affects between one and eight out of every thousand people. It is especially common in boys.
What are the symptoms of (Pectus Excavatum)?
The symptoms of this condition can affect both physically and mentally.
Physical symptoms:
- Difficulty breathing during exercise: You may feel like you're getting too breathless even when you're running or playing.
- Feeling tired more quickly than other peers: When playing with friends, you may feel tired before they do.
- Fatigue: Feeling tired all the time for no particular reason.
- Chest pain: Sometimes there may be chest tightness or pain.
- Irregular heartbeat: Feeling like the rhythm of your heart is changing.
- Heart palpitations: A sudden sensation of hearing the sound of your heart beating, or a feeling of it beating rapidly.
Mental symptoms:
Imagine, if you feel embarrassed and uncomfortable when you go swimming with your friends or playing sports because of this change in your chest... sometimes you might not even want to take off your T-shirt. Things like this can reduce your self-confidence.
- Intense shame and discomfort caused by the appearance of the chest.
- Self-esteem issues.
- In some cases, this condition can even lead to clinical depression .
What are the causes of (Pectus Excavatum)?
The exact cause of this condition in most people is unknown. However, in some people, it may be associated with connective tissue diseases such as Marfan syndrome or Ehlers-Danlos syndrome.
Is this a genetic thing?
Researchers have not yet been able to find a definitive genetic link to this condition. But they suspect that there may be a genetic influence . It has been found that between 40% and 53% of people with Pectus Excavatum have a family member who has the condition.
What are the risk factors for (Pectus Excavatum)?
Since the exact cause of this condition has not been identified, it is difficult to pinpoint the exact risk factors. However, if someone in your family has this condition, or if you have any of the previously mentioned syndromes that have been identified as being associated with it, you may be at risk of developing this condition.
What complications can occur due to this condition?
Complications that can occur with Pectus Excavatum include:
- Decreased ability to exercise.
- Mitral valve prolapse (a heart valve that does not close properly).
- Compression of your heart.
How is Pectus Excavatum diagnosed?
A doctor can diagnose this condition with a simple physical examination. In many cases, doctors may not notice it until you are young. They may do various tests to see how much the condition has affected your heart and lung function.
What tests are used to diagnose (Pectus Excavatum)?
Tests for this may include:
- A chest magnetic resonance imaging (MRI) scan.
- A chest CT scan.
- Cardiopulmonary exercise testing.
- Electrocardiogram (EKG).
- Echocardiogram of the heart.
- Pulmonary Function Tests (PFTs).
How is Pectus Excavatum treated?
A surgeon can correct this condition (Pectus Excavatum) either through a minimally invasive procedure (Nuss procedure) or an open procedure (Ravitch procedure) . Your surgeon will discuss with you which procedure is best for you. This procedure involves repositioning your breastbone (sternum) so that it is slightly raised. With both procedures:
- It reduces the pressure on your heart and lungs, allowing those organs to function better.
- Your chest is getting better.
If you have physical symptoms or are experiencing psychological distress due to Pectus Excavatum, surgery may be a good option for you. The best time to have surgery is between the ages of 10 and 14, when the chest wall is still flexible. Your doctor will help you decide the best time for surgery.
Nuss Procedure
This is the least invasive method. In this, the surgeon:
- A camera is inserted into the chest to guide the surgery.
- Two small incisions are made on each side of the chest.
- A specially designed, curved steel band or bands are inserted under the middle of the chest bone, and adjusted to lift that bone up.
- This belt is attached to the sides of the chest wall and eliminates that sagging appearance.
This steel band has to be left in place for several years. Then a surgeon removes it in a simple outpatient procedure (meaning you can go home the same day).
Ravitch Procedure
This is the traditional open surgery method. In this, the surgeon:
- An incision is made in the front of the chest.
- The overgrown connective tissue that pushes the middle of the chest bone inward is removed.
- The middle breastbone is moved away from the heart and lungs, pulled forward, and brought into the correct position on the chest wall.
- Then, using a small plate and small screws , or a small metal band, the middle of the chest bone is stabilized in the new position.
This metal band is removed after about 6 to 12 months in a short outpatient procedure. This band is smaller than the band used in the ``Nuss procedure.'' The plates are not removed, so no additional surgery is required.
Complications of treatment
Like any major surgery, surgery to correct Pectus Excavatum carries some risks. Both the Nuss procedure and the modified Ravitch technique are safe and effective. However, complications can occur rarely.
Possible complications of `(Pectus Excavatum)` surgery:
- Pneumothorax.
- Bleeding.
- Pleural effusion.
- Infection.
- Getting crazy from where the inserted belt was.
- Recurrence of `(Pectus Excavatum)` condition after removal of the belt.
- Damage to surrounding tissues.
- Chronic pain.
How long does it take to recover from this treatment?
With advances in pain management, recovery time after surgery is now shorter and less painful than before.
Cryoablation temporarily freezes the nerves in the chest wall between the ribs that sense pain. Local anesthetics are injected into those nerves before and after the surgery, and oral painkillers are also given.
Using this ``Cryoablation'' method to reduce the severe pain that occurs after the ``Nuss procedure'' has significantly reduced the length of hospital stay, as well as the need for painkillers such as ``Opioids''.
In the past, because it took about a month to recover from this ``Nuss procedure,'' school children had to have it done during the long holidays. But now, thanks to new pain management methods like ``Cryoablation,'' the hospital stay is shorter and the recovery is faster, so it can be done even during short school holidays.
Traditional pain management methods require a week in the hospital after the Nuss procedure. An epidural is also required, followed by several weeks of opioid painkillers that can be addictive.
But with Cryoablation, most people can go home the day after surgery. Some people don't need IVs or oral opioids at all while they're in the hospital. Even those who do need oral opioids can stop taking them in a day or two. Cryoablation can leave the chest wall numb for six months to a year.
Can Pectus Excavatum be prevented?
No. Until a specific cause of `(Pectus Excavatum)` is found, there is no way to prevent it.
If I have (Pectus Excavatum), what should I expect?
The main goal of Pectus Excavatum surgery is to reduce the pressure on your heart and lungs, allowing them to work better. This usually results in improved breathing, exercise difficulties, and chest pain. You may have felt that your breathing and strength were normal before the surgery, but it is only after the surgery that you realize how much better it is.
The main problem is that people who have an abnormal appearance of their chest have seen a significant improvement in their self-esteem and self-confidence after surgery. Adults with Pectus Excavatum may not notice any obvious limitations in their activities until their late 30s or 40s.
How long does (Pectus Excavatum) last?
You will have this condition until you have surgery to correct it.
When can I return to my normal activities?
After surgery, you will need to rest for a while because you will feel some discomfort. Once the discomfort has subsided, you can start walking and running again. Your surgeon will decide when you can start lifting weights and playing competitive sports again.
School-age children should be able to return to school within two to three weeks after `(Pectus Excavatum)` surgery.
What is the outlook for (Pectus Excavatum)?
Both the Nuss and Ravitch procedures have very good results. After recovery, people are generally satisfied with how they feel and look. The recurrence rate is less than 1% for both procedures.
How do I take care of myself?
For those with untreated `(Pectus Excavatum)`, both physical and psychological symptoms are a part of everyday life. While some may say, "It's just a cosmetic issue," they may not acknowledge what you're feeling. Find a doctor who understands your symptoms and can help you manage them.
When should I see my doctor?
Regular check-ups with your doctor will help them decide when you need surgery (or whether your condition is severe enough to require surgery). After surgery, you will need to see your surgeon on a regular schedule until you are fully recovered.
What questions should I ask my doctor?
Some questions you can ask your doctor about `(Pectus Excavatum)`:
- " Can you refer me to a counselor who can help me with the mental distress I am experiencing due to this condition?"
- " Is there a support group for people with `(Pectus Excavatum)`?"
- " Do you recommend surgery for my condition?"
- " At what age should I have surgery?"
Does (Pectus Excavatum) get worse with age?
Your symptoms may worsen over time. This is likely due to the normal aging process. Also, it becomes more difficult to compensate for the limitations placed on your heart and lungs by Pectus Excavatum as you age.
If I don't have surgery, will (Pectus Excavatum) damage my heart and lungs, or limit my lifespan?
There is no evidence that Pectus Excavatum limits life expectancy or damages the heart and lungs over time. However, your symptoms may worsen if you do not have surgery.
Women with `(Pectus Excavatum)` can have a normal pregnancy and give birth to a child.
If I have (Pectus Excavatum) and need heart surgery, can both procedures be done at the same time?
Yes. Surgeons have performed Pectus Excavatum correction surgeries along with heart surgeries with very good results. This requires good coordination between the surgeons performing both procedures.
Finally, take-home message:
Pectus Excavatum, a condition in which the chest bone grows abnormally, can be distressing due to its physical and psychological symptoms. Speak up for yourself and get the help you need for your symptoms. Don't be afraid to talk to your doctors about your condition. They are there to help you, just as they have helped others before you. If surgery is the right option for you, ask questions to understand what type of surgery is best for you. Remember, there are effective treatments for this condition, and you can live a healthy, active life!
` Pectus excavatum, sunken chest, chest pain, chest surgery, Nasal procedure, Ravitch procedure, shortness of breath, chest pain, sternum, congenital condition, sunken chest
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