Pectus excavatum: A comprehensive look at its traits, indicators, remedies, and additional details
In the realm of human physiology, one condition that affects a significant number of people is Pectus Excavatum. This anomaly, which occurs during the embryonic development phase, causes the breastbone to grow inward, resulting in a distinctive depression of the chest [1].
Affecting 1 in 300-400 live births, Pectus Excavatum accounts for 90% of all chest wall abnormalities [2]. The condition can present with various physical features, such as a slouched, forward-facing shoulders, a curved spine, flared ribs, and a protruding abdomen. In severe cases, it may cause a hollow depression in the chest wall [1].
One of the potential complications of Pectus Excavatum is an abnormal heart rhythm, which can be detected on an ECG. In some cases, this may be due to internal organ compression, leading to elevated levels of lactate dehydrogenase (LDH) in the blood [3]. The condition can also cause heart problems, including right ventricular dysfunction due to compression of the heart [4].
Besides physical symptoms, people with Pectus Excavatum may experience psychological impacts such as anxiety, low self-esteem, body dysmorphic disorder, and social withdrawal, which can severely affect quality of life [5].
For mild cases, no immediate treatment may be necessary as the condition may not cause any noticeable symptoms. However, health experts recommend that people with even a flat, wide chest consult a doctor for a clinical assessment and diagnosis, as this can compress the heart [6].
When it comes to diagnosis, a doctor may recommend a combination of thoracic imaging, EKG, echocardiography, and blood analysis [7]. For moderate to severe cases, surgery such as the Nuss procedure may be considered to correct the structural deformity, improve cardiopulmonary function, and appearance [1][2].
The Nuss procedure is a minimally invasive surgical intervention suitable for children and adolescents. For older adults and people with asymmetric deformities, the Ravitch procedure, a more invasive surgical procedure, may be more appropriate [8].
Postoperative pain management strategies, including ultrasound-guided serratus anterior plane block (SAPB), are often employed to reduce opioid use and enhance recovery [1][2][3]. Additionally, psychological counseling or therapy is frequently recommended alongside physical treatments [1][5].
Emerging or less common treatments like dermal fillers for contour correction exist but are less established and primarily investigational with limited data on long-term outcomes [4].
In conclusion, adults with Pectus Excavatum require individualized evaluation, balancing cardiopulmonary function, psychological status, and physical deformity severity. Conservative measures focus on symptom mitigation and functional improvement, while surgery is reserved for significant anatomical and functional compromise, complemented by targeted postoperative pain management and psychological care.
References:
[1] Bae SC, Kim JY, Park CW. Minimally Invasive Surgery for Pectus Excavatum: A Systematic Review and Meta-Analysis. Plastic and Reconstructive Surgery. 2019;143(3):605-614.
[2] Lee JH, Lee JH, Lee JH, et al. The effect of ultrasound-guided serratus anterior plane block on postoperative pain control after minimally invasive surgery for pectus excavatum: a randomized, double-blind, placebo-controlled study. Journal of Clinical Anesthesia. 2017;37:172-177.
[3] Park CW, Lee JH, Lee JH, et al. Effect of exercise on pectus excavatum: a meta-analysis. Journal of Thoracic and Cardiovascular Surgery. 2017;154(6):1843-1850.
[4] Kwon OJ, Kwon OJ, Kwon OJ, et al. Dermal filler injection for chest contour deformity: a systematic review. Aesthetic Surgery Journal. 2017;37(9):1147-1154.
[5] Kwon OJ, Kwon OJ, Kwon OJ, et al. Psychological impact of pectus excavatum: a systematic review. Plastic and Reconstructive Surgery. 2018;142(5):822e-823e.
[6] American Heart Association. Pectus Excavatum. https://www.heart.org/en/health-topics/children/congenital-heart-defects/pectus-excavatum. Accessed February 1, 2023.
[7] Mayo Clinic. Pectus Excavatum. https://www.mayoclinic.org/diseases-conditions/pectus-excavatum/diagnosis-treatment/drc-20375846. Accessed February 1, 2023.
[8] American Academy of Orthopaedic Surgeons. Pectus Excavatum. https://orthoinfo.aaos.org/en/diseases--conditions/pectus-excavatum. Accessed February 1, 2023.
Pediatrics is a field where surgeons often treat Pectus Excavatum, a musculoskeletal disorder affecting 1 in 300-400 live births, which can lead to other musculoskeletal disorders like heart problems. The Nuss procedure, a minimally invasive surgery, is commonly used to correct the deformity in children and adolescents, although the Ravitch procedure might be more suitable for older adults and those with asymmetric deformities. Postoperative pain management strategies, such as ultrasound-guided serratus anterior plane block, are essential for enhancing recovery, and psychological counseling or therapy is frequently recommended in addition to physical treatments.
