Best age for pectus excavatum surgery

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on September 05, 2024
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The best age for funnel chest surgery, according to the latest and most authoritative ninth edition of the surgical textbook, is between three and five years old. Historically, there has been controversy over the best age for funnel chest surgery, with some pediatricians previously believing it should wait until adolescence. However, it has been found that by the age of five, children start to become more aware and might realize their chest shape differs from others, potentially leading to feelings of inferiority and reluctance to make friends. Thus, performing the surgery before the age of five—before the child is fully aware of their deformity—might actually be preferable, as it could minimize psychological and physiological impacts. Of course, there is also a viewpoint supporting surgery before the age of three, but the younger the child, the softer the chest bone, which sometimes allows for other potential corrective methods.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus Excavatum should visit which department?

Pectus excavatum should be consulted with which department? Pectus excavatum is a type of congenital chest wall deformity, accounting for over 90% of all anterior chest wall deformities, and is primarily characterized by a depression in the middle of the chest wall that sinks inward and backward. As it is a congenital deformity, it can be noticed in children soon after birth, around the age of three to five, especially during bathing. This deformity may worsen with the patient's age, so you might consider consulting the pediatric health department. However, this indentation usually intensifies during puberty, and the pediatric health department primarily provides consultation services. If you seek a comprehensive assessment and treatment for pectus excavatum, you should consult the thoracic surgery department, which offers a range of treatments from surgical to non-surgical methods. Therefore, it is recommended to first consult the thoracic surgery department, followed by the pediatric health department.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Pectus excavatum causes

The etiology of pectus excavatum is not fully clear yet, but it has been found that the incidence of pectus excavatum greatly increases among patients with connective tissue diseases, possibly related to the disruption of the balance between growth genes and inhibitory genes affecting the cartilage on both sides of pectus excavatum. Moreover, it is also found that the complication of pectus excavatum significantly increases among patients with Marfan syndrome (also a type of connective tissue disease) and Noonan syndrome. In children with congenital airway stenosis and bronchopulmonary dysplasia, the incidence of pectus excavatum also significantly increases. This suggests that the causes of pectus excavatum are directly or indirectly related to genetics and heredity, and regardless, the causes of pectus excavatum, both acquired and congenital, are directly related to genes and heredity.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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What should be noted in daily life for people with funnel chest?

Since pectus excavatum is an inward and backward depression, such a depression may gradually become apparent even from a young age, especially worsening during adolescence. Therefore, children or patients with this condition should be aware of any significant lack of calcium or vitamin D. Of course, since pectus excavatum may also be somewhat related to familial genetic factors, it is important to check whether the child has any congenital heart diseases, Noonan syndrome, or connective tissue disorders. Since pectus excavatum causes an inward and backward indentation that compresses the heart and lungs, children with this condition may not be able to fully expand their lungs or completely relax their hearts. Consequently, these children tend to have a weaker constitution and may catch colds easily. Therefore, children with pectus excavatum should avoid crowded places, as their weaker constitution makes them more susceptible to colds, which can exacerbate their developmental issues, thus creating a vicious cycle.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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Causes of Pectus Excavatum

Although current medicine has developed to the molecular and genetic levels, the true causes of many modern diseases are still not completely clear, which includes pectus excavatum. There have been medical cases indicating that scientists have never ceased to explore the causes of pectus excavatum. It was once believed by early medical scientists that pectus excavatum might be caused by the inward and backward pulling of the sternum by the diaphragm. Therefore, for a period, the treatment for pectus excavatum involved releasing adhesions of the diaphragm, but this method was later found to be ineffective for children and was abandoned. Subsequently, it was discovered that pectus excavatum is somewhat related to the genetics of many families, such as those with Marfan syndrome (an autosomal dominant hereditary connective tissue disorder) and Noonan syndrome (a genetic disorder caused by mutations). However, no definitive pathogenic genes have been identified in families with sporadic cases of pectus excavatum. In summary, pectus excavatum is currently believed to be possibly caused by factors such as the development of rib cartilage on both sides, genetics, and other acquired conditions, like underdeveloped laryngeal cartilage or post-surgical factors from congenital diaphragmatic hernia repair. Overall, the causes of pectus excavatum are still actively being explored by medical scientists.

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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.