Thank you so much for such a wonderful podcast and review of the management of Pectus! I have a few questions that weren't addressed:
What do you do for patients who don't want surgery? I have a handful of patients with moderate to severe depressions and minor symptoms (mainly intermittent chest pain and respiratory fatigue with exertion) who do not want surgery. They are not heavy into exercise or sports and the depression doesn't bother them enough psycho-socially to pursue surgical intervention. I counsel them regarding the low risk of surgery and manageability of postoperative pain, however, they still just don't want to proceed with surgery. Would you still always get preoperative studies (chest CT, echo and PFTs) in these patients? I don't generally pursue the studies unless they want to proceed with surgery. And, I don't push them into surgery, reassuring them that they can live normal lives with the defect and that surgery is not mandatory. Is this management incorrect?
Also, what is your age cutoff for surgery? You discussed the optimal age for surgery, but is there an age cut-off that you hold to? Sometimes patients don't get sent to me till they are 17/18 years old -- i.e. after their pubertal growth spurt. Is this too late for surgical correction?
I would appreciate any suggestions you may have! Thank you so much!