How to treat pectus excavatum?

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on September 20, 2024
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There are many treatment methods for pectus excavatum, and the choice depends on the severity of the pectus excavatum, the age and chest wall elasticity of the child with pectus excavatum, the potential for further growth and development, and the expectations of the patient and their family. For younger children with pectus excavatum, where the chest wall is more elastic and soft, and in cases of mild pectus excavatum, a pectus excavatum suction cup can be considered. This device uses a certain amount of pressure, similar to a car suction cup, which is commonly seen in auto repair shops where a dented plastic bumper is gradually pulled out using a suction cup. This principle is also utilized by the pectus excavatum suction cup. Of course, this is under the premise that the patient is younger and has a softer chest, making it easier to be corrected by suction. For older patients with a harder chest, using a suction cup might not be appropriate, and surgical treatment may need to be considered. There are several surgical techniques available, ranging from the early Ravitch procedure, which involves a sternotomy and complete detachment of the sternum followed by flipping it, to the later Nuss procedure, and up to the current Wang surgical method and minimally invasive techniques.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum should see which department?

If the patient is relatively young, under 14 years old, and wishes to consult about pectus excavatum care, pediatric healthcare can be considered. However, if the patient is older, or in addition to pediatric healthcare advice, seeks information on how to treat pectus excavatum, it is advisable to consult with a local thoracic surgery department, if available. This is because thoracic surgeons offer not only information on the causes or care of pectus excavatum but also treatment options. Both conservative treatment plans and surgical interventions are available from thoracic surgeons. Of course, not all hospitals have a department of thoracic surgery, but general top-tier hospitals typically do; if there is no thoracic surgery available locally, considering general surgery might be the only alternative.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Can funnel chest heal itself?

Actually, a portion of children with pectus excavatum can heal on their own, especially those who are newly born and discovered to have pectus excavatum. This is because children are curled up while in the mother's womb. In some cases, their hands and feet might be placed in front of the sternum, pressing it backward and inward, causing a deformity. However, once the mother gives birth and the child's limbs unfold, the pressure on the sternum is relieved. As the chest grows, it gradually returns to its normal shape, and these children with pectus excavatum can be cured. On the other hand, another group of patients do not have pectus excavatum at birth, but develop a noticeable chest indentation as they grow older. These patients, when they are young, can also be treated with conservative methods, such as using a vacuum bell for pectus excavatum to gradually draw the indentation outward. With its stabilizing effect, as the child grows, the deformity can be slowly corrected. Of course, there are also children who might have a more rapid skeletal development, and essentially become "set" in their ways. At this stage, they may require surgical intervention to treat the condition. In summary, a portion of pectus excavatum patients can be healed, while another portion requires active intervention and treatment.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Is pectus excavatum hereditary?

Is pectus excavatum hereditary? According to modern genetic medicine, actually, about 80% of diseases are related to genetics to some extent, and pectus excavatum is no exception. Normally, pectus excavatum occurs in about one in 400 to 1000 people, with a higher prevalence in males. Research has also found that pectus excavatum is often seen in several genetic disorders, including Noonan syndrome, Turner syndrome, and Marfan syndrome. This indicates that it shares certain genes with these genetic disorders, such as the fibrillin-1 gene and others in the RAS/MAPK pathway. These genetic correlations may not always be evident, for example, the parents may not have pectus excavatum themselves. However, when parents with these recessive genes reproduce, their combination might result in pectus excavatum in their child. The development of pectus excavatum might be related to abnormal asymmetrical development of the cartilage. Thus, there is indeed a certain correlation between pectus excavatum and genetic factors.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Can funnel chest recover by supplementing with calcium?

There was a time when many parents consulted about calcium supplementation for pectus excavatum, not only many parents but also many doctors in primary hospitals thought that pectus excavatum was caused by a lack of calcium. However, it was found that many children with pectus excavatum are actually very tall and slender. So, can these tall children also be lacking calcium? In fact, calcium deficiency leads to rickets, where beading deformities form between the hard bones and cartilage of the ribs, appearing on both sides. This beading deformation and the inward, backward indentation of the sternum seen in pectus excavatum are completely different conditions. Pectus excavatum is mostly caused by congenital genetic factors, while calcium deficiency or supplementation relates to an acquired condition. Thus, these congenital and acquired diseases are unrelated, meaning that calcium supplementation has no restorative effect on pectus excavatum.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How to exercise to correct pectus excavatum

Pectus excavatum refers to the inward and backward indentation of the sternum, a deformity that can compress the patient's heart and lungs. To exercise for pectus excavatum, patients are advised to practice deep breathing exercises to enhance lung function, as well as engage in appropriate running and routine physical activities to strengthen heart function. However, in cases of severe pectus excavatum which severely compresses the heart, even pushing it entirely to the left side, patients may not be able to tolerate running and other intense activities. Therefore, it is quite difficult to completely correct pectus excavatum through exercise alone. Some parents might think that doing push-ups can correct pectus excavatum, but push-ups make the pectoral muscles on both sides stronger, and since these muscles pull outward, the force is not directed in the same way as the inward and backward indentation of pectus excavatum. Furthermore, continuously training the pectoral muscles causes them to develop, and the resultant thickening of the muscles on both sides can exacerbate the inward and backward indentation of the sternum in the middle. Thus, after appropriate cardiovascular and pulmonary exercises, those with severe pectus excavatum should still consult a doctor for active advice and consider surgical treatment options.