Pectus excavatum is caused by what?

Written by Zhang Zhi Gong

Cardiothoracic Surgery

Updated on September 20, 2024

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The specific etiology of pectus excavatum is not completely clear, but there are mainly two types of pectus excavatum: the simple type and the complex type, which means it is accompanied by other diseases. Currently, pectus excavatum is somewhat related to congenital genetic inheritance. This is because pectus excavatum is related to many connective tissue disorders, and many patients with congenital diaphragmatic hernias, psychogenic subglottic stenosis, and underdeveloped bronchopulmonary tissues also present with pectus excavatum. Although these diseases do not directly cause pectus excavatum, the reasons for the development of pectus excavatum, whether directly related to connective tissue disorders or not, are somewhat related to genetic factors. Therefore, it is currently considered that pectus excavatum is caused by genetic factors and inheritance.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

1min 26sec

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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.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

1min 24sec

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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

1min 18sec

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Can people with funnel chest work?

Whether pectus excavatum can affect work depends on two aspects. Firstly, if it is a mild case of pectus excavatum, with an index less than 3.25, such mild conditions do not cause significant compression on the heart or lungs, and the patient will not have too many work-related issues. However, if the pectus excavatum index is greater than 3.25 and the chest is sunken inward and backward, significantly compressing the heart and lungs, such a condition prevents the heart from fully relaxing and the lungs from fully expanding, which can impact the patient's activities. Besides the physiological impact, this condition can also significantly affect social interactions, especially for young children or adults. Some patients may suffer severe inferiority complexes, depression, and even suicidal tendencies, which, of course, will also affect their work capability and state. Therefore, for severe cases of pectus excavatum, it is recommended to wait until after treatment to return to work. Once the pectus excavatum is corrected, and the heart and lung functions are no longer compressed, and the appearance is normalized, the patient's work capability should be completely fine.

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Written by Zhang Zhi Gong

Cardiothoracic Surgery

48sec

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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

1min 8sec

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Does pectus excavatum require surgery?

The decision on whether surgery is needed for pectus excavatum depends on the patient's age, the severity of the deformity, and the elasticity of the chest wall. If the patient is very young, under one year old, and the pectus excavatum is not very severe, we recommend a watchful waiting approach. In patients with pectus excavatum under one year old, it is possible that the condition is pseudopectus excavatum, which may improve as they grow and develop within the first year. However, not everyone improves, with about one third of the cases showing improvement within the first year. If the child is older than one year, the likelihood of improvement is basically none, and at this time, conservative treatment using a pectus excavatum suction cup can be considered. If adhered to effectively, the suction cup can have a certain effect for some patients with pectus excavatum. But if the patient is over three to five years old and the chest wall has matured, surgery should be considered. Therefore, for the vast majority of patients with pectus excavatum, surgery is a relatively definitive and immediately effective method.