Is a funnel chest caused by calcium deficiency? Funnel chest is a deformity in which the sternum, rib cartilage and part of the rib cage are depressed toward the spine to form a funnel shape. In most funnel chests, the sternum starts from the level of the second or third rib cartilage backward to a point slightly above the saber process as the lowest point, and then returns forward to form a boat-like deformity. On both sides or laterally, the deformation is concave inward, forming the two walls of the funnel chest. In funnel chest, the rib alignment is more oblique than normal, and the ribs are depressed sharply from the top to the bottom, so that the front and back become closer, and in severe cases, the deepest depression of the sternum can reach the spine. Causes of funnel chest Some people believe that funnel chest is related to calcium deficiency in early childhood, which is incorrect. The cause of funnel chest is not well understood, and some patients have a family history. The incidence of funnel chest in patients with a family history is 2.5 per 1,000, while in those without a family history, the incidence of funnel chest is only 1.0 per 1,000. The heritability of funnel chest was studied in patients with a family history from the perspective of genetic disease. In the United States, 34 families with a family history were studied. 24 families were analyzed by genealogical analysis and chromosome analysis in cells, 14 of which were autosomal dominant; 4 families were autosomal recessive; and 6 families were sex-linked (X-linked) recessive. Thus, for those with a family history, funnel chest is actually a congenital genetic disorder. Most people believe that funnel chest is a deformity due to overdevelopment of the rib cartilage and ribs in the lower chest and compensatory backward displacement of the sternum. Symptoms of funnel chest Funnel chest is mostly seen in children under the age of 15, and rarely seen in patients over the age of 40, probably because funnel chest and scoliosis compress the heart and lungs and impair respiratory and circulatory functions, resulting in shorter survival time and death before the age of 40. A mild funnel chest can be asymptomatic, while a more severe deformity compresses the heart and lungs, affecting respiratory and circulatory functions, reducing lung capacity, increasing functional residual air volume, and reducing activity tolerance. Young children often have recurrent respiratory infections with cough and fever and are often diagnosed with bronchitis or bronchial wheeze. Young children have fewer circulatory symptoms, while older ones can present with dyspnea, rapid pulse, palpitations, and even pain in the precordial region after activity. The main country is because the heart is compressed, the cardiac blood output cannot meet the needs during exercise, and the myocardium is hypoxic, thus causing pain. Some patients can also develop arrhythmias, as well as systolic murmurs. The less severe symptoms of compression of the funnel chest in infancy often go unnoticed. Some have inspiratory stridor and sternal aspiration depression, but the cause of the airway obstruction is often not detected. Children are often thin, immobile, prone to upper respiratory tract infections, and have limited mobility. Exertional expiratory volume and maximum ventilation volume are significantly reduced. The child may experience panic, shortness of breath and dyspnea during activity. In addition to thoracic deformity, physical signs often include mild hunchback, abdominal protrusion and other special body shapes. Diagnostic tests for funnel chest Funnel chest is very easy to diagnose clinically and the deformity is obvious at a glance. X-ray examination shows a flat posterior portion of the rib cage and a sharp anterior and inferior decline, with the heart shadow shifted to the left side of the chest. There is a distinct radiolucent translucent area in the middle of the cardiac shadow, and the right cardiac margin often overlaps the spine. In individual patients with severe disease, the heart shadow can be located completely in the left thoracic cavity, and older patients have more scoliosis of the spine. In lateral chest radiographs, the sternal body can be seen to bend backward significantly, and in some cases the lower end of the sternum can reach the anterior edge of the spine. Posteroanterior photograph: transparent area in the cardiac shadow of funnel chest. Chest CT films can more clearly show the severity of the thoracic deformity and the degree of cardiac compression and displacement. The ECG may show inverted or bidirectional P waves of V1. There can also be right bundle branch conduction block, and cardiac catheterization can be traced to diastolic slopes and plateaus, the same as seen in constrictive pericarditis. Cardiac angiography shows right heart compressional malformations and right ventricular outflow tract obstruction. Funnel chest is very easy to diagnose clinically and the malformation is readily apparent. Complications of funnel chest If the thoracic deformity caused by funnel chest is serious, the heart and lungs of the organs in the thoracic cavity are compressed to different degrees, even causing the heart to be displaced and the pulmonary ventilation function is also affected, and if further developed, serious diseases such as respiratory tract infections can easily occur. Sometimes it can be combined with pulmonary dysplasia, Marfan syndrome, asthma and other diseases. Treatment of funnel chest The best and most accepted treatment for funnel chest is thoracoscopic minimally invasive correction of funnel chest. The minimally invasive thoracoscopic technique for the treatment of funnel chest involves making 2-3 (≈1.5 cm) small holes in the chest wall without cutting off the sternum and ribs. The procedure is suitable for patients with funnel chests ranging in age from 3 to 50 years old, as well as for patients who have failed to be treated with traditional surgery. The reduced incision area greatly reduces the incidence of complications; compared to traditional surgical treatment of funnel chest (such as sternal reversal) with open chest, the use of only about 1.5 cm chest wall “incision” reduces the surgical damage during the operation. For patients, the overall recovery time after surgery is greatly reduced and recovery is fast; the open chest surgical approach means that a large incision needs to be made in the chest wall, directly touching the entire chest cavity as the scope of surgery. The thoracoscopic surgical approach is to make only 3 “holes” in the chest wall with the help of TV camera technology and miniature lumpectomy instruments, and the contrast between the “3 holes” and the “centipede type” scars on the chest wall is more The “3 holes” are more aesthetically pleasing than the “centipede” scar on the chest wall. The thoracoscopic treatment of funnel chest also fully reflects its “minimally invasive” characteristics: the premise of ensuring the surgical effect, minimizing the surgical trauma, reducing the postoperative pain, shortening the postoperative recovery time, low cost of surgery, bleeding only about 10-30ml, no blood transfusion, etc. Limitations in age: Traditional surgery is very harmful to the patient due to the surgery itself, and being too old or too young in terms of physical recovery and tolerance will increase the risk of the surgery. Preventive care for funnel chest Funnel chest is a congenital and often familial condition. It is more common in males than females, with a reported male to female ratio of 4:1, and is a dominant trait. The main manifestation is that the sternum in the middle part of the anterior chest of a child leads the surrounding connected ribs to collapse inward into a funnel shape, which causes the organs in the chest cavity to be compressed or even displaced, and leads to a serious impact on the development and function of the heart and lungs of the child. The disease is familially dominant and there are no effective preventive measures. For children with less severe thoracic deformity, preventive measures should be taken to prevent its progression.