How to exercise to correct pectus excavatum

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on September 03, 2024
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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.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Harm of pectus excavatum

The dangers of pectus excavatum can generally be divided into two aspects: one is the harm to the physiological functions of the patient, and the other is the psychological impact on the patient. The physiological harm can be further divided into two categories: one is the impact on lung function, and the other is the impact on heart function. We can imagine that in normal individuals, the sternum is positioned in front of the heart and lungs. However, in patients with pectus excavatum, due to congenital hereditary or genetic factors, the sternum is pushed backward towards the spine, compressing inward and backward, which causes the heart to be squeezed, deformed, and the lungs to be compressed, preventing them from fully expanding. Thus, both the heart and lungs of the patient are subjected to certain pressures, affecting both cardiac and pulmonary functions. In addition to the impact on cardiopulmonary function, the patient's thoracic cage is deformed. It appears as if the center of the chest has been punched in. This kind of deformed chest affects the patient's social abilities, including interactions with potential boyfriends or girlfriends. Imagine, for instance, removing one's shirt at the pool in summer, attracting stares as if one were a monster. Therefore, patients may lack confidence, especially in romantic and social interactions, and some may even experience certain levels of depression or suicidal tendencies.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Does pectus excavatum hurt?

The sternum of pectus excavatum caves inward and backward, directly compressing the patient's heart or lungs, causing a certain degree of chest pain. This chest pain is not caused by pectus excavatum itself, but by the compression of the heart or lungs due to pectus excavatum. Imagine a normal ribcage as an oval shape; its cross-section is also oval and is a ratio of the patient's left-right diameter, transverse diameter, and anterior-posterior diameter. In normal individuals, this ratio is less than 2.5. In pectus excavatum, since the anterior-posterior diameter is significantly reduced and the sternum is markedly pressed towards the spine, the patient's heart is entirely compressed and deformed. Therefore, the patient's coronary arteries or valves may be squeezed and deformed, resulting in about 60% of pectus excavatum patients experiencing chest pain.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How is funnel chest formed?

Regarding the cause of pectus excavatum, there have historically been many hypotheses. For a while, medical experts believed that pectus excavatum was caused by the backward pulling of the diaphragm behind the sternum. Thus, for a time, surgeries abroad involved cutting the portion of the diaphragm behind the depressed area of the chest. Eventually, it was discovered that such cutting did not significantly benefit the treatment of pectus excavatum, and the results were not very conclusive. Therefore, this hypothesis was later debunked. To date, it is generally believed that the primary formation of pectus excavatum is somewhat related to genetic or hereditary factors. Of course, not all cases of pectus excavatum are due to parents having the condition; it might be present in the genes of ancestors and only manifest in the current generation or in this patient. Additionally, pectus excavatum could be associated with other diseases, such as connective tissue disorders. For example, some patients might have congenital diaphragmatic hernias, and after surgical repair, they could be prone to pneumothorax. Furthermore, some patients may suffer from pectus excavatum due to subglottic stenosis and underdeveloped bronchopulmonary structures, possibly triggered by respiratory factors. However, no matter the details, the formation of pectus excavatum is directly or indirectly related to congenital genes or heredity.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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What should be noted for pectus excavatum?

We know that behind the sternum of a normal person are the heart and lungs. Pectus excavatum is a deformity where this part of the sternum is pressed inward towards the spine. Such inward compression, as it occurs right against the bony spine, will directly squeeze the heart and in severe cases, can lead to insufficiency in the heart valve closure. Therefore, the most critical issue with pectus excavatum is the compression of the heart, which also compresses the lungs. Thus, 80% of children with pectus excavatum have lower exercise capacity compared to normal children, 60% may experience chest pain, and 40% have a significantly higher respiratory rate than normal children. Therefore, for patients with pectus excavatum, it is crucial to be cautious about common colds, as their respiratory and cardiac functions can be greatly affected if they catch a cold.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Harm of funnel chest suction cup

Recently, the use of vacuum bells for pectus excavatum has become very common in China, and their promotion has been very aggressive. However, for children using these devices, it's important to be cautious since they have pectus excavatum, a congenital deformity where the sternum is sunken inward and backward. One must ensure these patients do not have congenital heart diseases. If the patient also suffers from congenital heart defects like atrial septal defect, ventricular septal defect, or patent ductus arteriosus, using the vacuum bell to forcefully pull out the sunken sternum might lead to deformation of the heart and worsen the septal defects. Therefore, before using the vacuum bell, it is essential to rule out the possibility of congenital heart diseases in patients, which can be done through an echocardiogram. Secondly, using the vacuum bell with excessive force might cause bruising and capillary bleeding in the patient’s skin.