Pectus Excavatum treatment in adults

[bruinrab]

I'm fairly sure that I have this. It's mild to moderate, and although it's never been "officially" diagnosed, the typical symptoms are there (heart murmur without cardiac structural defects, poor circulation, shortness of breath with mild exertion, lack of endurance, small/visibly "deformed" ribcage).

It hasn't been something that I thought of getting treated until I put all the individual health problems together and realized that what we had attributed to familial anemia was probably because of this. I was wondering if anyone knows about the indications for treatment in women over the age of 18 (I'm thinking in terms of decreasing cardiopulmonary function with age, concerns about future pregnancy, etc) and the various procedures that are available (method, safety, recovery time, etc). Thanks.

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[Idiopathic]

The surgery is brutal. I imagine the recovery is even moreso.

 

[dave262]

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=14726081&dopt=Abstract

thats the link to the procedure. Not too many surgeons actually perform it on adults, prbably less than 10 in the whole country. Lots of pain. Insurance likely wont cover it. ~$15000-30000.
You wont be allowed to carry a backpack for 3 months.

 

[bruinrab]

Hmm. Seems a lot more negative than everything else that I'd read. Any ideas on the different procedures?

 

[dave262]

actually of all the pe treatments, thats the most minimally invasive, safest, and least scarring.

 

[iam]

bruinrab,

i am sorry to hear about your problem. idiopathic, are you talking about the nuss technique? based on what i have heard, it is not brutal. it is normally done in younger patients only, but that doesn't mean that it's not possible for an adult. i don't think bruinrab should rule it out if there is a valid concern about future health issues.

of course, you might not have any problems in the future if the deformation is mild, but i can completely understand why you would want to look into correction. check with a number of surgeons and compare their suggestions- the sooner the better. if it is necessary to do something, you can take advantage of the superior healing capacity of your relative youth!

you need to have someone take a look at this so that you can evaluate the specifics relevant to your situation. sorry i can't be of more help; mainly i wanted to offer some words of encouragement.

iam

ps: if you can prove that the condition is causing you distress and points to health risks, i don't see why the surgery wouldn't be covered (provided that you have a good insurance policy.)

good luck!

 

[bruinrab]

Thanks iam. I can understand the concerns with Nuss -- it seems that the reason it works so well with kids is because their bones are still relatively flexible, and I may have lost that advantage at this point. Hopefully I'll be able to figure out what to do, and if I even want to do anything. My mother had major thoracic surgery in October of '02, so watching her recovery (slow, painful and still not complete) has given me an idea of how bad it can be -- and more incentive to get it out of the way while I'm young. The only problem is that I'm leaving my job in a month, and I won't have proper insurance again until August, when I begin med school. Still, that will give me time to get things sorted out and get it done over the summer between first and second year (if I end up deciding to do anything).

Decisions, decisions!

 

[FliteSurgn]

are you talking about the nuss technique? based on what i have heard, it is not brutal.

I don't know, but shoving that steel bar through the mediastinum (blindly) is a little scary. In my experience, the procedure is very painful. That is especially true the older the patient is at the time of the procedure.

it is normally done in younger patients only, but that doesn't mean that it's not possible for an adult. i don't think bruinrab should rule it out if there is a valid concern about future health issues.

I know of no surgeons that will perform a Nuss on someone over 16-18 years old. The rib cage/sternum are just not pliable enough after that. The performance benefits (SOB, exercise tolerance, etc.) seem to be theoretical at best. In SEVERE cases of excavatum, it may be justified but anything less really is just cosmetic.

 

[dave262]

I know of 3 surgeons who will perform it on patients up to age 26. One of them is Dr. Nuss himself. Just do a quick google search for adult nuss.

 

[Idiopathic]

I sat in on one this summer, performed on a 26-year old excavatum Px. The surgery consisted of an approximately 6 inch incision, followed by severing all the costal cartilages, and using cautery/pliers to remove 0.5-1.5 inch segments of each rib. After this forceful procedure, the ribs were lain back in the chest to, I assume, 're-form' with the sternum...I do know that the young man had what seemed like significant blood loss early on, and I also have not been through a surgical rotation, so I have no idea what this procedure is supposd to entail. The surgeon who performed this procedure is very well known locally.

P.S. I have no idea what this technique is called.

 

[bruinrab]

Sounds like Ravitch. No way I'm getting that done.

 

[tussy]

I have seen the procedure done on young adults. Yes, there is a long recovery period and a significant degree of pain. The procedure is purely cosmetic (therefore not covered by most insurance plans). There is no evidence that surgically correcting a pectus excavatum gives any clinically significant change in physiological parameters.

 

[praying4MD]

I have seen a 33 year old who had the Nuss procedure performed. unfortunately, he was in a lot of pain and later had to have the bar removed due to his recurring pain and inability to return to normal activity level.

The Nuss works beautifully in children, when performed by the right hands. I am slightly skeptical of its use in the adult population, especially after speaking with this particular patient.