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
1min 22sec home-news-image

Why can't people with funnel chest gain weight?

In clinical observations, we have found that children with pectus excavatum generally do not have as good nutrition as normal children, and are not as plump. This may be related to the deformity of the chest indentation. We know that the normal cross-section of the thorax on a CT scan is oval-shaped, with the heart and lungs located behind the sternum. In children with pectus excavatum, the sternum is compressed backward toward the spine, which deforms and even pushes the heart completely to one side. This compression of the heart limits the blood's ability to fully return to the heart, and may even prevent the valves from closing completely, leading to valve insufficiency. As a result, both cardiac and pulmonary functions are somewhat impaired. Therefore, 80% of children with pectus excavatum experience exercise intolerance, meaning they cannot run as well as normal children, which also indicates poorer physical fitness and, comparatively, a lesser appetite. Recent studies have found that children with pectus excavatum also have slightly weaker immune functions, and their digestive and absorption capabilities are not as good as those of typical children. Poor exercise capacity and digestive function ultimately lead to poorer nutrition in children with pectus excavatum, making them less plump than normal children.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Minimally invasive surgery for pectus excavatum

Pectus excavatum minimally invasive surgery currently comes in two varieties. The first resembles a variation of the traditional Nuss procedure, which involves making a small incision under the patient's armpit and inserting a pre-shaped trapezoidal steel plate through this small hole to the back of the depressed breastbone. The steel plate is then flipped to push out the depression. Because it requires only a one to two centimeter incision on the patient, it is considered much less invasive compared to the traditional Nuss procedure which requires two incisions. There is also another type of minimally invasive surgery which involves bilateral incisions but does not require flipping the steel plate, thus avoiding damage associated with flipping and muscle disruption between the ribs. This is also considered a current minimally invasive surgical technique. Additionally, there is the recent Wang procedure, which is also minimally invasive, requiring only one incision and not necessitating access behind the breastbone. However, it is generally suitable only for younger patients with softer breastbones. For older adults, the Wang procedure might not be appropriate and further observation is required.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Can funnel chest be cured?

In fact, many diseases cannot be completely cured, including the common cold, for which there is currently no way to completely eradicate it, meaning there isn't a medicine that, once taken, prevents one from ever catching a cold again. Of course, this has a lot to do with the mutations of the cold virus. However, pectus excavatum can be cured, and there are generally two methods of treatment for it: surgical and non-surgical. The surgical method is suitable for older patients with harder bones. Conservative treatment is appropriate for younger patients with more elastic rib cages, who can cooperate well, or whose family can supervise and support them through this non-surgical approach. Regardless, it is completely possible to cure pectus excavatum, and there are methods to do so.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum heart hazards

Pectus excavatum can harm the patient's or child's heart, primarily manifesting in compression of the heart and affecting the function of the internal heart valves. Imagine a normal person's rib cage, which is oval in cross-section. There is a certain ratio between the lateral diameter and the anterior-posterior diameter, with normal individuals having a ratio of less than 2.5. However, in patients with pectus excavatum, this anterior-posterior diameter is significantly compressed, meaning the sternum moves closer to the spine, compressing inward and backward, squeezing the heart - this is the first step. The heart itself is a contractile muscular organ, its purpose being to eject blood and circulate it throughout the body. If the sternum and spine directly compress the heart, preventing it from fully expanding, then blood cannot fully flow back into the heart, and thus the ejection or pumping function of the heart will be impacted. Secondly, besides the heart being compressed, just like a house becoming deformed from being squeezed, the doors within the house cannot function properly; they cannot close or open well. Thus, pectus excavatum not only compresses the heart itself but also severely harms the function of the heart valves, even causing mitral valve prolapse in some patients.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Minimally invasive surgery for pectus excavatum

Minimally invasive surgery for pectus excavatum has evolved over the decades, with various surgical methods developing since the most classical NUSS procedure introduced by Donald Nuss in the 1990s. His basic surgical process involves administering general anesthesia to the patient, who is then laid flat on the operating table. A horizontal line is drawn from the deepest part of the depression to the armpit, where one to two small incisions are made under the armpit. The skin is then freed to access the chest cavity, and a steel plate is gradually inserted behind the sternum at its deepest point, after which the depressed sternum is elevated by flipping the plate. Of course, there have been improvements to the NUSS procedure, such as the modified Nuss procedure that reduces the flipping process, thus minimizing the impact and damage to the bones. For instance, ultra-minimally invasive surgeries, which require only a single-port incision, have evolved from the NUSS procedure by reducing or eliminating the need for flipping or an incision. Later, the Wang procedure involved placing the steel plate in front of the sternum, using the principle of a suspension bridge to elevate the depressed sternum. Thus, the evolution of surgery for pectus excavatum continues to advance, with the surgical processes improving, wounds becoming smaller, and the number of incisions decreasing.