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So in terms of the visit, after we’ve done the history, then we move on to the physical exam. I’ll examine your chest, or your physician will examine your chest, listen to your heart and lungs, do a look at your back, see if you have scoliosis or not, note if there’s any rib flaring, note what kind of pectus excavatum you have, and do a regular physical exam to look for any other problems that you might have. On physical exam, we can notice that there is a pectus excavatum. What we can’t tell is how severe the defect is. We don’t know how close your sternum is to your spine just by looking. For that we need to do some tests. The best test that we have for this are 3D images. Things like MRI or CT scan are used to evaluate this area and your chest wall shape.
MRI is slightly different than CT scan. It takes slightly longer, but there’s no radiation at all involved. There’ve been some problems with radiation in children leading to cancers, in people leading the cancers, later on in life. And it’s based on the amount of dosage that you receive. So we try to minimize any kind of radiation exposure by doing an MRI instead. The other thing that we need to know of is how it’s actually affecting your function. So once we know that your defect is severe, we’d like to do an echocardiogram. This is an ultrasound of your heart to see if there are any abnormalities within your heart itself. This can also look at your aorta and see if you have any of the aortic root dilation that’s sometimes common with Marfan’s disease. So when you go for the echocardiogram, we have you go to a cardiologist and they will read your echocardiogram after the ultrasound is done, and that’s painless.
You’re awake for that. It’s an ultrasound probe with some jelly on your chest, and they just take pictures of it. Very easy to do. The more vigorous tests that actually require some input on the patient’s part have to do with pulmonary function tests and the stress test. For the pulmonary function tests, you go to a pulmonologist and there’s a machine that they use, and they’ll have you take deep breaths and blow into a machine and they measure the way that you breathe and how well and efficient you’re breathing. For the stress test, it’s an exercise test, and that measures the amount of oxygen capacity that your body has. And those are important because oftentimes the pulmonary function tests are abnormal with patients with pectus excavatum, but more abnormal with exercise than at rest. So that test is very important. We found that over time or after your repair, that those indices improved significantly. So once these tests are done, then we discuss with the surgeon again the indications for repair. Dr. Nuss is a surgeon who came up with the Nuss procedure and published this, and has criteria that are accepted by insurance companies.
