Sunken Chest Syndrome Surgery Helps Equestrian Get Back on Her Horse

When Michelle Miller was 7 years old, she was diagnosed with pectus excavatum (PEX), commonly referred to as sunken chest syndrome. A congenital condition that causes the chest wall to curve inward, PEX can cause symptoms that only appear or worsen in adolescence or young adulthood.

Michelle began to experience symptoms, including mild chest pain, shortness of breath, and a reduced ability to exercise, while in middle school. Years later, when Michelle decided to turn her love of horses into a career in equine facilitative therapy, she started having difficulty completing some of the heavy duties required as part of her coursework at Wilson College in Chambersburg, Pennsylvania.

After a visit with her Virtua family doctor, Michelle learned that her symptoms are common, but often misdiagnosed or dismissed, among people with PEX. 

“My primary care physician ordered imaging tests that showed that my chest wall was compressing my heart and pushing my liver to the side,” said Michelle, 21, of Delran. “I knew I needed to do something about my condition because of how much it was affecting my life.”

Finding Symptom Relief
Anxious to explore treatment options that might relieve her symptoms, Michelle met with Matthew Puc, MD, Virtua Health’s chief of thoracic surgery and a regional leader in minimally invasive surgery to correct PEX in adults. 

“When Michelle first came to see me, her symptoms had progressed to the point where she couldn’t do the heavy work or exercise that she was used to,” said Dr. Puc. “Symptoms caused by PEX are often misdiagnosed because some physicians may view PEX as cosmetic and not a big deal, or may not realize that a patient’s symptoms are related to the condition.”

Dr. Puc told Michelle about a minimally invasive procedure to treat PEX that would involve inserting two titanium bars under Michelle’s breastbone to push her chest wall forward. Over about three years, Dr. Puc said, Michelle’s chest wall would remodel itself into the proper position around the bars. After the remodeling process is complete, the bars could be removed.

“I didn’t want my condition to affect college, my career, or my ability to compete on my school’s equestrian team, so I decided to have the surgery,” said Michelle. “I wasn’t very nervous because I knew I was in good hands, and Dr. Puc assured me that the surgery would help.”

Getting Back on the Horse
Dr. Puc performed Michelle’s procedure in May 2019 at Virtua Marlton Hospital. After a few days, Michelle returned home — complete with some “serious internal bling.”

Michelle said that although she knew she had a long healing process ahead of her, she noticed improvements in her symptoms early on. After three months, she was able to return to normal daily activities. After six months, she was able to (literally) get back on the horse, gradually increasing her participation in equine competitions and activities.

“The surgery was life-changing. I didn’t realize how limited I was before my surgery. I couldn’t jog more than a mile, and I would hold my breath when I rode,” said Michelle. “Now, I’m not short of breath when hiking, riding, or doing other activities. I’m not limited by my body anymore.”

Dr. Puc said he has heard similar statements from his patients who had PEX surgery.

“After their PEX is fixed, many patients realize just how much their condition was affecting their life,” he said.

Michelle, now a senior in college, returns to Virtua to see Dr. Puc for occasional follow-up visits. She will need another surgical procedure to remove the bars at the three-year mark. 

“I can’t say enough about how wonderful everyone at Virtua has been during this process, and I am grateful for how they worked together to get me where I am today,” Michelle said.

Updated February 4, 2021

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