Dr Child's Casebook – Off Your Chest
A pressing sense of pressure in their chest recently prompted a member of the public to seek Dr Child’s advice. Their long-established pectus excavatum was producing increasing discomfort around the sternum area. To relieve the pressure, they were tempted to create a vacuum bell but sought guidance before doing so. Medically savvy, the caller was able to fashion their own pharmaceutical instruments and had recently read the of the bell’s effectiveness in the correction of pectus problems.
Q: I’m a medically savvy middle-aged man with marfanoid features including a pectus excavatum that is now troubling me, hindering my breathing. I am also losing my stamina such that a car journey longer than 30 miles is exhausting. Given surgery to correct this is exclusively private, would a vacuum bell work as a non-invasive cheaper option?
A: Pectus excavatum (a depressed, funnel chest) constitutes the most common congenital anterior chest wall deformity. Along with pectus chest carinatum (pigeon chest) it affects up to 70% of people with Marfan syndrome. Its symptoms match those you describe including breathlessness, palpitations and an inability to perform physical activities at the same level of intensity as one’s peers. Psychologically speaking, its impact varies according to the individual from trivial to profound.
Pectus surgery can be sought through the NHS by family doctor referral to a thoracic surgeon. I would strongly recommend an appointment to discuss the wider picture, including respiratory function tests to see if your lungs are affected. And of course, a cardiology assessment to make sure you do not have early heart failure. Both these conditions are treatable, and perhaps your lack of stamina could be improved, and is not entirely due to pectus effect.
Given your age, your situation is not conducive to the vacuum bell. The suction technique is only useful when the pubertal child is actively growing and the ribs are supple, and able to move position. For the adult, when the ribs are fixed, surgery is the only option if the condition is causing symptoms. It can be redeemed only by surgical intervention. Before the operation you must be assessed with either two-view chest radiographs, limited computer tomography or a contrast tomography.
Surgical correction of pectus excavatum is most commonly performed using either the Nuss or Ravitch procedure. Given the former is usually reserved for children or young adults who have not yet reached skeletal maturity, it is the Ravitch procedure that is relevant to you.
In the Ravitch procedure, an incision (cut) is made from one side of the chest to the other. The cartilages are cut away on each side and the sternum is flattened. In pectus excavatum (sunken sternum), one or more struts (metal bars) may then be inserted to help the sternum keep its shape. This is the procedure most suitable for you where the deformities are stiffer.