Can funnel chest recover by supplementing with calcium?

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on April 08, 2025
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There was a time when many parents consulted about calcium supplementation for pectus excavatum, not only many parents but also many doctors in primary hospitals thought that pectus excavatum was caused by a lack of calcium. However, it was found that many children with pectus excavatum are actually very tall and slender. So, can these tall children also be lacking calcium?

In fact, calcium deficiency leads to rickets, where beading deformities form between the hard bones and cartilage of the ribs, appearing on both sides. This beading deformation and the inward, backward indentation of the sternum seen in pectus excavatum are completely different conditions. Pectus excavatum is mostly caused by congenital genetic factors, while calcium deficiency or supplementation relates to an acquired condition. Thus, these congenital and acquired diseases are unrelated, meaning that calcium supplementation has no restorative effect on pectus excavatum.

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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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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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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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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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Can people with funnel chest gain weight?

The majority of pectus excavatum cases encountered clinically are congenital thoracic deformities, which means the sternum in the middle of the chest is indented inward and backward. This inward and backward indentation can compress the lungs and the heart, especially in severe cases of pectus excavatum, causing significant compression to the lungs and heart. It prevents the heart from fully expanding, and might even push the entire heart into the left chest cavity, also preventing the lungs from effectively expanding. Therefore, children with this condition tend to have weaker constitutions, are prone to colds, and their ability to engage in physical activities like running is not as good as other children. Pectus excavatum generally affects the development of children, especially in severe cases. Mild pectus excavatum involves only a slight indentation and does not severely compress the heart, and children with such a condition can still gain weight if their nutrition is adequate. However, in severe cases of pectus excavatum, besides impacting the heart and lungs, it can also affect the patient's personality, self-confidence, and social interactions, potentially leading to insecurity, depression, and even suicidal tendencies.