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Logan received his Pectus Excavatum, (PE) diagnosis in April 2015 when we visited Mayo Clinic for a pediatric endocrinologist appointment follow-up-he’s been seeing Dr. Seema Kumar since April 2014 for Growth Hormone Deficiency (GHD) and Idiopathic Short Stature (ISS). When we arrived, we found out she was out of the office unexpectedly with a sick child. In her place, we saw Drs. Nofal and Lteif to advise us on his progress made with his GHD over the last 3 months. They were alarmed by the large/deep indentation in his chest area with concern that as he progresses through puberty, this would become even deeper and push his heart and lungs out of place, ultimately leading to a decrease in lung capacity, scoliosis, heart issues, etc. We were referred to see Cardiothoracic Surgeon Dr. Christopher Moir for his PE. Dr Moir is perhaps best known for his coordination of and leading Mayo’s surgical team to separate multiple sets of conjoined twins. We met with Dr. Moir in August 2015 and were told his Haller Index was 3.8 which was concerning. We’ve continued to follow up since every 6 months. Dr Moir wanted to see progression made with age, growth, and weight gain before doing surgery. Rule of thumb with this deformity is that as a person grows, and goes through puberty, the PE becomes worse hence giving the patient a higher Haller Index number. With Logan having GHD getting the approval for him to start Growth Hormone Therapy (GH) became even more critical as he wasn’t growing normally on his own and would need this GH in order to have the correction surgery before his bones would start to become more rigid as he’s near adulthood. After 3 insurance denials, tons of testing, calorie intake modifications, etc. he was approved for GH March 2016. We have continued to see great progress with his growth velocity since-it is now 11.4 cm (4.49 in) per year in comparison to 2.2 cm (0.87 in) per year in February 2016.
Reporting back to Mayo and Dr. Moir in October 2017, Logan was found to have made tremendous strides with his growth and weight-thanks to GH-and would now be considered a candidate for surgery this coming summer. His chest wall deformity had slightly worsened, presenting mild asymmetry along the left border of the sternum. His chest compression begins at midsternal level and continues to his xiphoid process, with rib flaring, and some scoliosis. His Haller Index now measures 4.54 mm-this is considered to be a moderately severe defect with him showing evidence of cardiac compression, however the mediastinum has not shifted to the left side yet which is good. Ideal candidate age for surgery is between ages 14 and 16 in most patients as a patient’s bones are still soft enough to allow for correction with the strut(s) or bars being placed.
Here's a YouTube video depicting what is typically done during the PE surgery -
https://www.youtube.com/watch?v=e2XYHhd7ciA https://www.youtube.com/watch?v=ULwkA77yEHEWe will meet with Dr. Moir on February 16th to review any progress made and set a date for his PE correction surgery. We are wanting to get this scheduled as early as possible this summer to allow for enough rest and recovery time before returning to school. This surgery is considered to be one of the worst a patient could ever have. Thus he, and our family, are trying to prepare for what’s at hand this upcoming summer as the road to recovery will take months. Please continue to keep Logan and our family in your thoughts and prayers as we continue to find out what lies ahead.
