Pectus excavatum heart hazards

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on September 28, 2024
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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 24sec home-news-image

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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Can people with pectus excavatum join the military?

Theoretically, the current conscription system does not have strict restrictions on mild cases of pectus excavatum. However, obvious moderate or severe pectus excavatum, or sternums that are inwardly and backwardly concave, can significantly impact the function of both the heart and lungs by compressing them. This inward concavity can restrict the heart’s ability to fully expand, potentially causing complete deformation of the heart, or even prevent the heart’s valves from closing fully, leading to valve regurgitation. Such compromised cardiac and pulmonary functions are likely unable to withstand the physical demands experienced during military service. Therefore, for moderate and severe cases of pectus excavatum, we do not recommend enlisting in the military, although the current policy does not have clear restrictions on mild cases of pectus excavatum.

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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.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How to treat pectus excavatum?

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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Is pectus excavatum scary?

Is pectus excavatum scary? In a normal person, the thoracic transverse diameter and anteroposterior diameter have a normal ratio. For example, in normal individuals, this ratio of the transverse diameter to the anteroposterior diameter is less than 2.5. However, some children, due to congenital or acquired reasons, may have a sternum that is concave inward in the middle. In such cases, the concavity of the sternum significantly reduces the anteroposterior diameter, and the ratio of the transverse to anteroposterior diameter then becomes greater than 2.5. For pectus excavatum where the ratio is between 2.5 and 3.5, we suggest conservative treatment or observation, and a pectus excavatum suction cup can be used. If the ratio is greater than 3.5, the pectus excavatum is very pronounced, and we recommend surgical treatment. In severe cases of pectus excavatum, where the ratio of the transverse to anteroposterior diameter is greater than 4, there are instances where the chest is almost touching the back, with only a few millimeters of space between the anterior chest wall and the spine during surgery. In such severe cases, the heart is completely pushed to the left side of the patient, significantly affecting both cardiac and pulmonary function, impacting the patient’s physical development. In severe cases, it can also cause significant psychological issues, including severe feelings of inferiority, lack of self-confidence, poor social skills, and even severe depression or suicidal tendencies. Therefore, severe pectus excavatum can indeed be quite frightening.