21 February, 2008

So, I am pretty sure I have Pectus Excavatum

I think I might go to the doctor to get this checked into, but here is some information on it, what it is, how it can affect me, and options for correction of it.

Pectus excavatum (A Latin term meaning:Hollowed chest) is a congenital deformity of the sternum, which is pressed into the chest, resulting in a "caved-in" or sunken appearance. It is usually present at birth, but in some rare cases does not appear until the onset of puberty.
Commonly called "funnel chest," pectus excavatum is a depression or hollow caused when the sternum (breastbone) is abnormally pushed inward. The depression in the chest is due to abnormal growth of the cartilage that attaches the sternum to the ribs.

The deformity is sometimes considered to be a cosmetic rather than functional problem. However, recent studies have shown cases where pectus excavatum has impaired cardiac and respiratory function, and sometimes caused pain in the chest and back.

The expansion of the lungs during breathing or exercise which is important to maintaining normal respiratory function is confined because the chest wall cannot expand. Thus, more intensive and rapid respiratory rate is necessary. Also, the diaphragm is called upon to make larger movements to provide enough oxygen and carbon dioxide exchange to meet the demand of the body under exercise conditions. More energy is thus utilized for breathing and contributes to fatigue, in contrast to the normal individual.

In moderate and severe pectus excavatum, the heart can be compressed and displaced into the left chest. This may limit the amount of blood the heart can pump per beat. This may become evident when the patient exercises and his heart has to beat faster to compensate for this compression. In addition the defect may reduce the amount of air entering the lungs. This again can become evident during exercise when the patient feels that he cannot keep up with his peers secondary to shortness of breath. Other problems include pain as well as the psychosocial effects of having a deformed chest.

It is unfortunate that this defect has been deemed cosmetic over a long period of time. Primarily because of the fact that very young patients are frequently asymptomatic. The defect has thus remained for long periods of time into the teenage and later age group periods before the real symptomatology expresses itself. The ideal age for correction of this defect is between 12-18 years of age and the simplicity of the repair in this age group makes this the ideal period for repair.

The standard pectus repair (Ravtich approach) of these deformities has been to place a sternal bar (Adkin's Strut) behind the sternum after mobilizing the deformed cartilages around the sternum and then go through a second operation to remove the bar after approximately 12 months following the initial repair. The Nuss Procedure involves the placement of a large curved bar through incisions on the chest wall. The bar is rotated into position and kept in place for 2 to 3 years.

The incision is a transverse curvilinear incision beneath the breasts, which gives a good cosmetic scar. The lower 4-5 cartilages are removed and the perichondrium or the covering of the cartilages is left in place. Then a wedge osteotomy or wedge is taken out of the sternum and depending on whether there is asymmetry the sternum is tailored obliquely according to the defect. A sheathed wire then is placed behind the sternum and then brought out through the muscles and skin and later attached to a modified brace for a period of 12-15 weeks depending on severity. During that period of time, the cartilages reform in the new position and the defect, thus, is corrected. The patients are fit with a brace prior to surgery which is a light vest to which the wire is attached at surgery. Patients can return to work within a week after surgery and children may go back to school within that period of time. Blood administration is unnecessary. The complete healing period is 3 months after which individuals can return to their normal activities. Recurrence is very unusual with this operation.

So, yeah this is basically the jist of it all.

No comments: