Pectus Excavatum Surgery Eases Pressure on Jacob’s Heart

When he was 14 years old, Jacob was diagnosed with pectus excavatum, a condition that was causing pressure on his heart. Fortunately, surgery was able to correct his condition. Today he’s back to running and playing volleyball, and his heart is no longer in jeopardy.

In the summer of 2015, Jacob Cline, then age 14, came to Cincinnati Children’s for intestinal surgery. As he was being prepped for his procedure, his doctor noticed his chest was sunken in. That’s when he first learned he had a condition called pectus excavatum.

Also called funnel chest, pectus excavatum is a depression in the chest caused when the sternum, or breastbone, is pushed inward and creates a concave area in the chest. The depression occurs because of an abnormal growth of the cartilage that attaches the sternum to the ribs. The condition ranges from mild to severe, and the indentation can vary from not too noticeable to extremely obvious. In severe cases, the sternum pushes on the heart and lungs and can lead to serious medical problems.

Jacob and his parents, Tony and Erin Cline, had never heard of the condition before Jacob’s diagnosis. Jacob hadn’t complained of any related symptoms, which can include shortness of breath, chest pain and fatigue. In Jacob’s case, he experienced some chest pain during long runs with the cross-country team, but nothing so severe that he thought he had a significant medical problem. “Every now and then my chest would hurt but I didn’t really think anything of it,” Jacob says.

Concern for Jacob’s Heart

 Jacob next underwent a series of tests to determine if he was a candidate for surgery to repair the depression. Not everyone with pectus requires surgery. But Jacob’s tests showed that one of his heart valves was not operating at full capacity. His care team at the Chest Wall Center suspected this was due to the lack of space between his sternum and heart. “It made the decision to have the surgery a no-brainer because the heart was affected,” Erin says. “So we went ahead with getting it scheduled.”

“The doctors said I could possibly have problems with my heart when I was older if I didn’t get it fixed, and that’s what made me want to get the surgery done,” Jacob says.

Jacob was a freshman in high school at the time. The Clines scheduled the surgery for Jacob’s three-week Christmas break to give him time to recover before returning to school. He had what’s called a Nuss procedure, a minimally invasive surgery where surgical instruments are placed into small incisions made in the chest. During the surgery, the sternum is lifted to a normal position. Then curved steel bars are inserted into the chest just below the sternum, and are affixed to the ribs with sutures. The steel bars stay in the chest for three to five years, to allow the chest to adjust to and remain in the new position.

An Experienced Team

The goal of the surgery is to improve the patient’s breathing, posture and heart function. The specialists in the Chest Wall Center at Cincinnati Children’s have extensive experience performing surgery to repair pectus excavatum. They were early adopters of the Nuss procedure in the early ‘90’s, and performed nearly 90 Nuss procedures last year alone. Jacob’s surgeon, Rebeccah Brown, MD, has been performing pectus repairs since the start of her career more than 20 years ago.

Patients undergoing this procedure, upon waking from the anesthetic, see an immediate difference in their appearance, as the chest depression is completely gone once the surgery is over. Recovery afterward can be painful, but the Cincinnati Children’s team of specialists in Pain Management and Integrative Care are available around the clock to assist in administering and prescribing medications, to offer massage therapy, and to help with practicing mindfulness to manage the pain.

In the early weeks of recovery, it’s important that the steel bars don’t shift. So Jacob couldn’t twist his upper body and was limited in using his arms. He had several restrictions for the first four to six weeks after surgery.

“Recovery was pretty hard,” recalls Jacob. “I had to sleep sitting upright. I couldn’t lie down for two to three weeks. And it was a few weeks before I could use my arms to sit down, or to stand from a sitting position.” Despite all that, once his three-week break was over, he was able to return to school. “I couldn’t carry my backpack, but I didn’t have to miss my classes,” Jacob says.

Three months later, Dr. Brown cleared him for non-contact sports.

Determined To Do Well

“I am so impressed with how he got through this whole thing,” Jacob’s mom says. “He kept a positive attitude even when he couldn’t do a whole lot. He knew he needed to do the day-to-day work to get to where he needed to go.”

After being cleared by Dr. Brown, Jacob became the manager for the volleyball team at his high school. Now he’s looking forward to playing sand volleyball over the summer, and hopes to play for his high school team next year.

It’s been six months since surgery, and Jacob says the results have been great. “I don’t feel any more chest pain. I ran two-and-a-half miles yesterday on the treadmill and felt fine,” he says. His cardiologist expects his heart to fully recover.

“He’s being careful about the activities he does to make sure his chest isn’t bothering him,” Erin says. “He has some exercises to do to help with stretching.” Those exercises will also help his chest muscles grow and strengthen.

'In the Best Hands'

The steel bars in Jacob’s chest will be removed three years after his original surgery in an outpatient procedure, over Christmas break of his senior year in high school.

“This is a scary surgery to think about your child going through, but I knew he was in the best hands he could have been in,” Erin says. “We’re so grateful that Cincinnati Children’s is so knowledgeable in this area, and that it’s right here in our backyard. We are very blessed that everything has gone as well as it has.”

When asked what he would tell others in his shoes, Jacob’s thoughts are short and sweet, but powerful. “It’s pretty life changing,” he says.