It was only at the age of 31, while pregnant with her first baby, that Ingrid Dammann’s ever present healthcare condition – a sunken chest with a deeply dented breastbone – was finally identified as a serious concern requiring medical intervention.
Until that moment her ‘constant elusive companion since birth’ was viewed as little more than a cosmetic problem – at worst a supraventricular arrhythmia or irregular heart rate, a small hiatal hernia or simply acid reflux.
Six years and two pregnancies later Ingrid recalls that even though pectus excavatum (PE), as it was later diagnosed, is the most common chest wall skeletal deformity it was never something that any medical practitioner had previously paid much attention to or even referred to by name. “The phrase ‘there’s nothing wrong with you’, uttered during many a medical investigation, would to me become the most unnerving and frustrating verdict. It was, in retrospect, the loneliest road I’ve ever walked,” she says.
Ingrid, who lives in Glencoe, near Dundee in KwaZulu-Natal with her husband and three young children, spent the last month of her first pregnancy on bed rest, before her baby was born by caesarean section at 36 weeks. “Prior to being confined to my bed I could not drive myself to work without having to pull over due to dizziness and breathlessness. As an occupational therapist, the active therapy sessions that I had with physically and mentally impaired children caused the muscles in my upper and lower extremities to become completely stiff, leaving me gasping for air while fighting light-headedness,” she says.
“For the first time ever the specialists I was consulting took my complaints seriously, but they still could not find clear answers to my problem. After recovering from the caesarean section, the symptoms I experienced during pregnancy did not disappear and my health did not return to what by now was considered ‘normal’ for me. My heart and my chest were more problematic than ever, leaving me deeply anxious.”
| Pic: Dr Ivan Schewitz and his patient Ingrid Dammann. In the photograph Dr Schewitz is demonstrating exactly where the Nuss stainless steel bars, which remained in place for more than three years were placed in Ingrid’s chest, to ensure that her chest wall correction would remain stable. |
| Pic: Ingrid Dammann with cardiothoracic surgeon Dr Ivan Schewitz, a pioneer in his field, following the recent removal of the Nuss bars at Netcare Waterfall City Hospital in Midrand. Commenting on the difference Dr Schewitz has made in her life she says: “When thinking of the lonely road I walked for so many years I consider myself extremely fortunate that I finally crossed paths with a knowledgeable, capable surgeon. Even now I find it hard to explain how my quality of life has changed for the better.” |
In search of the solution
While scouring the internet for a solution Ingrid found an electrophysiologist and a cardiothoracic surgeon and in 2019, at the age of 33, she had a cardiac ablation to treat her abnormal heart rhythm. Her problems were however not behind her as the root cause of her condition had not been resolved. After ongoing research and reaching out to countless specialists she finally received a positive response from cardiothoracic surgeon Dr Ivan Schewitz, a pioneer in his field, credited with introducing thoracoscopic surgery as well as the minimally invasive repair of PE, using the Nuss procedure, to South Africa.
For Ingrid, the consultation with Dr Schewitz finally delivered the solution that she had been so desperately looking for over many years but just after being scheduled for the Nuss procedure, she found out that she was pregnant with her second child.
“Particularly because of the healthcare issues I faced during my first pregnancy, I decided to go through with it and I was 16 weeks pregnant at the time that I had the Nuss procedure. Though this may be considered controversial, for me it was well worth it even though, at times, it was most uncomfortable and painful – particularly on top of being badly impacted by morning sickness,” says Ingrid.
PE and the Nuss procedure
“PE is a congenital condition in which the breastbone has a distinctive and unusual inverted appearance. This is caused by the overgrowth of the cartilage adjacent to the breastbone which, when growing too fast, pushes the breastbone in – this is called excavatum. In Ingrid’s case her sunken chest put pressure on her lungs and heart. This was further exacerbated by her pregnancy due to the elevation of her diaphragm which would not only have caused unbearable discomfort but also chest pain and breathing difficulties,” notes Dr Schewitz who practises primarily from Netcare Waterfall City Hospital in Midrand but also works from a number of other Netcare hospitals around the country.
Dr Schewitz explains that during the Nuss procedure two small incisions are made on the side of the chest so that a stainless steel bar can be inserted behind the deformed breastbone from where it is attached to the outer edge of the ribs.
“In Ingrid’s case two bars were inserted to correct the problem. It is rather disquieting that for so many years this condition has been considered purely cosmetic, however, a growing interest in the benefits of the minimally invasive Nuss procedure has helped us to realise that the condition is so much more than cosmetic.
“Not only does PE cause the chest to have a distinctive and unusual inverted appearance, but it tends to displace the heart to the left of the chest cavity, thereby compressing its right ventricle. It also results in restricted movement of the chest wall,” he adds.
Typical symptoms may include shortness of breath, fatigue, chest pain, a rapid heartbeat or heart palpitations, frequent respiratory infections, coughing or wheezing, as well as the psychological effects of living with this condition.
A second and a third pregnancy
Following the procedure Ingrid experienced uncomplicated pregnancies, giving birth to two healthy children with the Nuss bars in place.
“During these two pregnancies I had no breathing difficulties and was still gardening up until I gave birth. I was not feeling my heart pounding in my chest anymore. By the time our second baby arrived, I had recovered enough from the surgery to be able to cope with the postpartum demands,” says Ingrid.
“The stainless steel bars, which remained in place for just over three years to ensure sure that the chest wall correction was stable, were recently removed at Netcare Waterfall City Hospital. Due to her third pregnancy the procedure, which saw her going home after just a day in hospital, was slightly delayed,” explains Dr Schewitz.
“When thinking of the lonely road I walked for so many years I consider myself extremely fortunate that I finally crossed paths with a knowledgeable, capable surgeon. Even now I find it hard to explain how my quality of life has changed for the better,” concludes Ingrid.
Ends
Notes to editor
Dr Ivan Schewitz operates from the following Netcare hospitals: Netcare Waterfall City Hospital in Johannesburg, Netcare uMhlanga Hospital in KwaZulu-Natal, Netcare Greenacres Hospital in Gqeberha and Netcare Christiaan Barnard Memorial Hospital in Cape Town.
Pectus excavatum is a condition in which the person's breastbone is sunken into the chest. In severe cases, pectus excavatum can look as if the centre of the chest has been scooped out, leaving a deep dent. The traditional repair has been an open destructive operation the Ravitch procedure in which the sternum is fractured and multiple rib cartilages are removed. The modern procedure is the Nuss procedure, an operation designed by a South African born and trained surgeon which is a minimally invasive thorascopic procedure in which no bone is fractured.
This operation was introduced to South Africa in 2008 and is now the recommended procedure. Traditionally the condition has been considered cosmetic only but we now have a great deal of information showing the effects on the heart and lungs as well as the major psychological problems that these children develop.
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