Less than a year after having corrective chest wall surgery at the Children’s Hospital Foundation (CHF) Heart Center at Children’s Hospital of Richmond at VCU (CHoR), 15-year-old Ethan Andrews can run a mile in seven minutes and 24 seconds, a sport he started only six weeks after surgery. A member of his high school’s soccer and basketball teams, his endurance has improved, and he no longer needs to hunch over to catch his breath when exerting himself.
Diagnosed with pectus excavatum when he was five years old, Ethan saw his pulmonologist regularly to check his lung function. For years, Ethan’s mom, Kelly, said he “passed with flying colors,” but during his 13-year check up, Ethan’s doctor advised the teenager to have additional testing done at CHoR. After those tests, Kelly said, “we got results we weren’t expecting. His lung capacity was down to 85 percent, and his heart was compressed and not pumping as efficiently.”
Although not fatal, pectus excavatum, a condition where the sternum is sunken into the chest and can interfere with heart and lung function, tends to become more severe during adolescence. It is the most common congenital deformity of the chest wall and affects one in 300 to 400 individuals, including three times more boys than girls.
Ethan’s cardiologist, Scott D. Gullquist, MD, Associate Professor, CHoR, recommended Ethan have surgery and referred him to Thomas Yeh, Jr, MD, PhD, FACS, Director, Children’s Hospital Foundation Heart Center, and Chief, Cardiac Surgery, CHoR. In August 2016, Ethan and his parents, Kelly and Wade, met with Dr. Yeh who recommended Ethan have the Nuss procedure, a minimally-invasive approach that uses small incisions under the arms and internal scopes to place one or more internal braces, or bars, under the sternum to push it forward.
Dr. Yeh began performing the Nuss procedure in 1999, a year after it was first reported in medical journals, and has performed hundreds of procedures since that time, including 35 since arriving at CHoR in 2014 to establish the CHF Heart Center. Funded by a 10-year, $28 million pledge from Children’s Hospital Foundation, the CHF Heart Center works with a variety of specialists in cardiology, anesthesia, surgery, perfusion, pediatrics, nursing, pharmacy, respiratory therapy and others to offer services ranging from fetal cardiology and interventional cardiac catheterization to surgery and transplant. Last August, Joanna Rosenthal, MD, Associate Professor, CHoR, the only fellowship trained fetal cardiologist in the region, joined the Heart Center team.
Knowing that Ethan would need a couple months to recover, and after consulting with Dr. Yeh, the Andrews decided to schedule Ethan’s surgery for May 2017 so he would have the summer to recover. Following surgery, he spent four days in the Pediatric Intensive Care Unit with one or both parents with him around the clock.
“Every morning Dr. Yeh would invite Wade and me to be a part of the rounds and listen to [the team] talk about Ethan and look at his x-rays,” Kelly recalled of the days in the PICU. “We also found out that [Ethan’s condition] was more serious than we thought. His heart was [compressed by pectus] into the shape of a kidney bean.”
“There are two reasons to operate on patients with pectus excavatum,” said Dr. Yeh. “One is to repair the chest compression that limits physical activity. The second is to improve self-esteem and body image, which can be devastating for young men at Ethan’s age. Ethan is already reaping the benefits of surgery, which I hope will give him a much more functional life.”
Although Wade said Ethan never seemed bothered by the appearance of his chest before surgery, the teenager also didn’t like to take his shirt off at the pool or around friends. “We see a difference in his self confidence now,” Wade said.
Ethan’s surgery involved the placement of two bars, which will be removed in three years once the bones reshape. His recovery went well, but when Ethan developed two small hematomas (swelling of blood outside of the blood vessels) under his right arm last fall, Kelly said, “Dr. Yeh and his team were there no matter what time of day and worked us in to be seen the next day.”
Because of the timing of the hematomas, Ethan, who has been playing soccer and basketball for eight years, missed most of his freshman sports seasons, but he’s looking forward to playing this coming year. Other than avoiding sports like football and activities like water skiing and tubing while the bars are in, Ethan has resumed normal activities and travels from his Louisa County home every three months for check ups with Dr. Yeh.
“To be able to sit with a doctor, not feel rushed, have all your questions answered and get information you never thought to ask was amazing,” Wade said of their experiences at CHoR. “It was also helpful that all of Ethan’s tests were on the same floor” at the Children’s Pavilion.
“Dr. Yeh really cared,” said Ethan, who aspires to be a sportscaster. “He explained things well. The surgery was definitely worth it.”