UHNM leads on treating patients with sunken chest

UHNM is leading the way in treating patients living with chest wall abnormalities which can cause problems with breathing, walking and carrying out everyday activities. A multi-professional team of clinicians at Royal Stoke University Hospital and Staffordshire University are developing new ways of investigating patients to help improve their lives.

Pectus Excavatum, also known as 'sunken chest or 'funnel chest', can be a debilitating condition and until recently, doctors have not been able to measure its effects on the heart and lungs. 

Laura Scott, 34, of Rugeley, Staffordshire, was diagnosed with the condition at a very young age and had surgery to help correct the condition.  

Laura said: "For years, even the simplest of everyday activities were a challenge for me. Everything from walking to the shops to climbing the stairs was a nightmare and used to leave me feeling breathless and exhausted. When I was younger at a school I really struggled in my PE classes because I was so much slower than the other children and teachers thought I was just being lazy. I used to only wear certain kinds of tops and lots of layers to cover myself up and even deliberately put weight on to disguise the abnormal shape of my chest. As I got older and began working, I found that I just couldn't manage physically."

Laura went to see Mr Chris Satur, Cardiothoracic Surgeon, for a round of in-depth investigations, including exercise testing and respiratory and imaging procedures. Two years ago she underwent the Ravitch procedure, where a metal plate and bar are inserted into the chest to help correct the abnormality.

Laura said: "Having treatment for my condition has been life-changing. As soon as I had the surgery it was as though my lungs had been opened up and now I go running several times a week and really enjoy exercising.  I can do everything other people can, but I don't take anything for granted – I love that I can now take a full, deep breath. In my current job I'm sometimes required to go and pick supplies and things up from our warehouse. Before my treatment this would have been a really difficult and unpleasant task, but now I don't have to worry about how many trips I make, I just enjoy every step. I am a much more confident person and feel more physically capable to look after myself and live life." 

Mr Chris Satur, Cardiothoracic Surgeon, said: "Pectus excavatum prevents a person being able to lead a normal life and carry out daily activities which most of us take for granted. It's really important that people realise this is not just a cosmetic issue. but a physical one. Unfortunately, there is a lack of research on a worldwide scale and many people are being left to struggle along with little hope of a solution.  

"At UHNM we wanted to change the understanding of the problem and improve treatments available by providing comprehensive assessment of all patients. We have gathered very detailed tests in order to work out why and how the condition affects the patient and are working to drive a culture of change in patient care through better understanding. We have collaborated with the Mayo Clinic in Arizona, USA and were invited to present the results of investigations with surgeons at an international conference in South Africa. We are seeking to work with NHS England to help patients who suffer with the condition now and we want to help move research forward."

He added: "Through these multiple strands of investigation we have been able to clearly demonstrate that patients are severely disabled by chest wall abnormalities. For example, they are often unable to engage in normal exercise or sport, cannot enter careers of choice and experience psychological stress. We hope that in the future our work will help to enable patients to receive treatment. Currently, funding is unavailable to provide treatment to patients as NICE due to a lack of evidence available  and we hope our studies will provide the evidence to gain re-institution of treatment of these patients."

The use of imaging technology is also helping to identify the nature of the problem.

Dr Nick Watson, Cardiothoracic Radiologist, said: "Imaging shows how the breast bone dips deeply into the chest and causes compression of the heart and lungs. In addition to playing a key role in assessing the severity of the condition, it also guides the optimal surgical approach for repair.  Use of the state-of-the-art imaging technology at UHNM ensures the highest quality information is obtained to inform the patient's management."

Ian Cliff, Head of Respiratory and Sleep Physiology at UHNM, said: "We provide Cardiopulmonary Exercise Testing (CPET), a vital tool that provides detailed analysis of exercise responses involving the lungs, heart, vascular system and skeletal muscle systems.  The detailed results allow enhanced evaluation of the patient and provide relevant information for clinical decision-making. We have been supporting the work of Mr Satur for a number of years and have been able to develop our understanding of chest wall abnormalities and their effect on patient's exercise tolerance and quality of life."

In addition to imaging services and physical investigation, psychological tests have also been undertaken to help form a detailed view of the patient's overall condition.

Karen Rodham, Professor of Health Psychology at Staffordshire University, has been undertaking interviews of patients before and after their corrective surgery to evaluate the impact on patient's lives.

Professor Rodham said: "The opportunity to have in-depth conversations with people who are living with chest wall abnormalities is providing the team with greater insight into the physical and emotional challenges of the condition which until recently was wrongly thought to be 'just cosmetic'. This means that we are truly able to treat the whole person, which is incredibly important in aiding and enhancing someone's recovery."