Pectus excavatum is not caused by calcium deficiency. 10 misunderstandings about pectus excavatum

Pectus excavatum is a chest deformity characterized by a depression in the anterior chest wall. According to statistics, its incidence rate is approximately 0.1-0.8%. However, most patients use clothing to cover up their deformities, so the number of patients who are actually known is not as high as the incidence figures reveal. At present, even many doctors in society do not know much about this disease, and patients and their families are full of doubts about the disease.

Recently, the Public Health Network summarized clinical cases and various misunderstandings of patients about pectus excavatum, and roughly summarized the following ten misunderstandings:

Myth 1: Pectus excavatum is caused by calcium deficiency

"The connection between calcium deficiency and rickets has long been confirmed, but rickets refers to abnormal development of bones throughout the body. If this abnormality occurs in the thorax, it often manifests as pigeon chest or complex deformities, and rarely as funnel chest. Therefore, the occurrence of funnel chest has little to do with calcium deficiency." Director Wang explained.

However, to this day, in the pediatric and even thoracic surgery wards of many hospitals, doctors still explain to patients that calcium deficiency is the cause of pectus excavatum, causing children with pectus excavatum to take calcium supplements endlessly. Not only did this fail to achieve any therapeutic effect, it also delayed the best time for treatment for the patient, causing the patient to suffer both physically and mentally.

Myth 2: Pectus excavatum is a genetic disease

According to Director Wang, there are many theories about the pathogenesis of pectus excavatum, three of which are more representative: the first is the compression of the thorax by the limbs during fetal period; the second is the uncoordinated development of various parts of the thorax; and the third is genetic factors. All three theories make sense and seem to explain the pathogenesis of some patients with pectus excavatum. But not all patients can be explained by one hypothesis, which means that at least some patients' diseases are not caused by genetics. In clinical practice, there are indeed cases where fathers and sons, brothers and even several generations of relatives all have pectus excavatum, but more patients do not have any signs of family inheritance. Director Wang believes that the statement that pectus excavatum is a genetic disease is not entirely correct.

Myth 3: Mild pectus excavatum will not compress the heart

Director Wang said that for some patients with mild pectus excavatum, since they do not show symptoms of heart compression, when the doctor tells them that the heart may be compressed, the patients often misunderstand the doctor's intentions and develop resistance.

In fact, for healthy people, the sternum and heart are close together. A normal person's sternum has a certain compression effect on the heart. When the sternum is concave, this compression is difficult to avoid. All patients with pectus excavatum, as long as there is a depression in the sternum, will inevitably compress the heart regardless of the severity. The only difference is the degree of compression and whether symptoms occur.

Myth 4: Pectus excavatum can be restored to normal through exercise

Pectus excavatum is a deformity of the thorax. The thorax is a bony structure that has its own specific developmental patterns. Physical exercise mainly changes the shape and volume of muscles. Changes in muscle shape can only cover up the shape of bones, but it is difficult to change the shape of bones. Therefore, it is impossible to correct funnel chest through muscle exercise.

Some young patients always place their hopes on chest muscle training. They hope to enlarge the pectoralis major and rectus abdominis muscles and fill the hollow in the chest cavity. But even if plump muscles can improve the degree of the depression, it cannot change the shape of the bones, let alone relieve the pressure on the heart and lungs.

Myth 5: It is impossible for patients with pectus excavatum to gain weight

In people's general impression, many patients with pectus excavatum are relatively thin people, and many people believe that it is impossible for patients with pectus excavatum to gain weight. Director Wang has found in clinical practice that patients with pectus excavatum can have various body shapes. There are many older patients with pectus excavatum who are actually fat, but there are also many thin patients with pectus excavatum who even take the initiative to eat themselves into fatness in order to improve their chest deformity.

Myth 6: Mild pectus excavatum does not require surgery

Whether or not funnel chest requires surgery needs to be considered from two aspects: first, whether there are serious symptoms, and second, whether it is very ugly. The former is mainly determined by doctors, while the latter is mainly determined by patients. For patients with severe pectus excavatum deformity, symptoms are often more severe. In such cases, the opinions of doctors and patients are relatively consistent, and patients often take the initiative to request surgery. However, for milder deformities, if there are no obvious symptoms, that is, the lesion is very mild, doctors do not recommend surgery, which is in line with common sense in general medical treatment.

Myth 7: NUSS surgery can treat all cases of pectus excavatum

There are many corrective surgical methods for pectus excavatum. The currently popular NUSS surgery has become the standard procedure for treating pectus excavatum. This makes many people wishfully believe that NUSS surgery is a panacea and can satisfactorily correct all types of pectus excavatum deformity. This is actually a wrong perception.

Regardless of the type of pectus excavatum or its severity, all NUSS surgeries involve simply raising the plate from the bottom of the depression. For any satisfactory orthopedic surgery, the most ideal surgery should be individualized and meticulous correction based on the characteristics of the deformity to ensure that the surgery can achieve the best effect in each different deformity. Obviously, NUSS surgery is not such a delicate surgery.

Myth 8: NUSS surgery after or as a secondary surgery for congenital heart disease is very dangerous

Because the cardiac surgery and thoracic surgery departments in some institutions are independent of each other, and congenital heart disease surgery belongs to cardiac surgery, while pectus excavatum surgery belongs to thoracic surgery, many cardiac surgeons cannot perform or are not good at pectus excavatum surgery. As a result, a large number of children with pectus excavatum who cannot complete the surgery during cardiac surgery have appeared in clinical practice.

In a general NUSS operation, the most critical step is to pass the steel plate through the gap between the sternum and the heart. If the gap no longer exists due to heavy adhesions, the heart is likely to be punctured during the placement of the plate, causing fatal bleeding. In fact, as long as the surgical route, incision location, and operation sequence are reasonably designed, any secondary surgery is actually very safe and will not be as scary as some doctors and patients say.

Myth 9: The sooner you have surgery for pectus excavatum, the better

Most children with pectus excavatum are diagnosed when they are very young. Once parents discover such a problem, they always rush to the hospital to see a doctor as soon as possible and hope to treat their children as soon as possible. This is the wish of most parents. However, due to the special structure of the chest cavity of young children, surgery cannot be performed at a very early age. If the plate is inserted too early, it will limit the development of part of the thorax that is compressed by the plate. For children under 2 years old, if their condition is not too serious, no surgical method is suitable, so it is best not to consider surgery.

Myth 10: The fewer incisions in orthopedic surgery, the less trauma

Many people think that the number of incisions directly determines the size of the trauma, and the fewer incisions, the smaller the trauma. When all other procedures are equal, the number of incisions can be positively correlated with the degree of trauma. But in pectus excavatum surgery, the real trauma is often not the damage caused by the incision, but comes from other more important aspects. Take the NUSS operation as an example. The most traumatic part of the operation comes from the sunken chest wall being forcibly propped up. This process is similar to forcibly bending or even breaking normal limbs, and the extent of damage can be imagined. Therefore, the real trauma of pectus excavatum surgery does not only come from the number of incisions, but is also affected by many other factors. The reduction in incisions mainly affects the postoperative aesthetics and has little to do with the overall trauma level.