Dr. Janani Reisenauer: Adult pectus excavatum is one of the most common congenital chest wall deformities, and it occurs in about one and 200 live births with a predominance in males. It oftentimes can be detected right at birth, but often doesn't bring attention to itself until the child is going through adolescence because that's when certain features such as exercise intolerance or cosmetic defects might really bring themselves to light and the child might really become more aware and more conscious of it.
Dr. Dennis Wigle: In terms of referral for patient evaluation, I think from our perspective, it's the situation where someone's symptoms really can't be explained by the more common things that can happen to the heart. So for example, the you know, the valvular function is normal, the myocardial function is normal. There's no obvious underlying lung disease. And so frequently, we see situations where all of the routine more common stuff is really had a good look and without a clear answer as to why the patient's experiencing what they are. And that's really where it's an appropriate point to really take a deeper look for somebody who's either got a known pectus or maybe where there's even a question of having a pectus or the degree of it, in terms of whether that's really a causative factor for someone experiencing what they are, Dr. Janani Reisenauer: We work in a very multidisciplinary fashion, both with our pain team, our pediatric surgical colleagues, but also recently with radiology. We work in very close association with our 3D anatomic printing lab. And we've currently designed a mechanism where we take the patient's CT scan and incorporate it into a model that allows us to predict what placing that bar would ultimately result in in terms of the patient's postoperative cosmetic appearance.
Dr. Dennis Wigle: The contour of the bar that we're actually bending under sterile conditions in the OR, with the patient on the table can be done guided by the 3D imaging in order to try and have something as matched as best we can to that patient's defect. So the pain management for for pectus is really one of the critical parts. It's really important that someone's in a position where they're comfortable enough to be able to get up, walk around, deep breathe, cough, and that's not only critically important in the hospital early when they're recovering from the procedure, but also those first few weeks or months that they're at home and having a an individualized treatment plan for their pain management so they really can get on with their life with bars in place while we're waiting for their chest wall to remodel and really be in a position to safely take them out. Across all of our three sites, we are the largest volume pectus institution, certainly for adults in the country, and there's tremendous benefit that comes from that. In order to be able to do the procedure, do it well, do it with a low complication rate and really get the result that everybody's looking for.
