Northern Virginia | Services: Children's Hospital Foundation Heart Center
Preparing to Take Flight
Fifteen-year- old Connor Shelton wants to join the Air Force. So much so that he had surgery last summer to improve his chances for a military career.
Diagnosed with pectus excavatum, a condition where the sternum is sunken into the chest and can interfere with heart and lung function, Connor first learned about his diagnosis in March 2013 after fainting during a chorus performance at his Stafford County school. Although not fatal, pectus excavatum tends to become more severe during adolescence. It is the most common congenital deformity of the chest wall and affects one in 300-400 individuals including three times more boys than girls.
Connor’s chest indentation, which can be seen in photos beginning around age nine, started becoming more noticeable around the time of his diagnosis. The following summer he became so exhausted during a family snorkeling trip that his father, Craig, had to help him back to shore. A member of the Civil Air Patrol, the United States Air Force Auxiliary, since he was 13, Connor attended activities with the Fredericksburg Squadron once a week and monthly physical training where he had to run and complete other physical activities that often left him short of breath.
“Connor never complained,” said his mom, Susan, who began researching physicians to repair his condition after his snorkeling incident.
Children’s Hospital Foundation Heart Center
Susan’s research led her to Thomas Yeh, Jr., MD, PhD, FACS, Director of the Children’s Hospital Foundation (CHF) Heart Center, Children’s Hospital of Richmond at VCU (CHoR), and Chief, Pediatric Cardiothoracic Surgery. Funded by a 10-year, $28 million pledge from Children’s Hospital Foundation, the CHF Heart Center was established with the recruitment of Dr. Yeh in late 2014 to provide the full spectrum of care for children with heart disease. Working with a variety of specialists in cardiology, anesthesia, surgery, perfusion, pediatrics, nursing, pharmacy, respiratory therapy and others, the CHF Heart Center offers services ranging from fetal cardiology and interventional cardiac catheterization to surgery and transplant.
In March 2015, Connor, Susan and Craig met with Dr. Yeh. Connor had a series of tests including a CT scan, chest x-ray, echocardiogram, cardiology consultation, cardiopulmonary exercise test and allergy testing to ensure he was not allergic to the stainless steel bar that might be used to repair his chest.
“Dr. Yeh was very thorough,” Susan recalled. “He didn’t leave us with any questions.”
After meeting with Dr. Yeh, Connor said he felt he had three options, which included not doing anything or undergoing one of two surgical procedures developed to repair pectus excavatum.
“Based on severity, there are two reasons to repair pectus excavatum – self-esteem and physical issues including endurance,” said Dr. Yeh, who also noted that frequent upper respiratory infections and pneumonia, which Connor had, can be symptoms of the condition.
Of the two surgical procedures, Connor underwent the newer Nuss procedure, which uses two small incisions under the arms and internal scopes to place an internal brace, or bar, under the sternum to push it forward. The bar is usually removed after three years once the bones reshape.
Dr. Yeh, was an early adopter of the Nuss procedure, first learned about the surgery in 1999, a year after it was first reported in medical journals. He has performed hundreds of procedures since that time, including 22 at CHoR. Connor’s surgery, which occurred on June 17, 2015, was the second such procedure Dr. Yeh performed in Richmond.
“We were confident in Dr. Yeh’s ability to complete the surgery,” Susan said, “but I still had worst case scenarios going through my head. When they let me see Connor after surgery, I cried. I was relieved that part was over.”
Getting Back to Business
Following surgery, Connor spent five days in the hospital. Because pain is carefully managed after surgery, Connor had an epidural for three days but only needed pain medications twice after discharge. Throughout the six-week recovery, his activities were limited to walking, using stairs and lifting no more than five pounds.
Although Connor wasn’t able to play in the waves or ride roller coasters, two of his favorite pastimes, because of the risk of blows to his chest last summer, when he was able to resume physical activities, he said he felt like it was easier to recover after exerting himself and that his average heart rate had decreased. Eight weeks after surgery, Connor completed 50 push-ups. A year later, he was doing 100 push-ups a day, jumping waves in the Outer Banks and riding roller coasters at Kings Dominion. He has also resumed modified karate practices, which will continue until the bar in his chest is removed.
“He’s having big improvements,” Dr. Yeh commented after Connor’s one-year check-up. He noted Connor’s reports of being able to run farther and faster including finishing first in a physical fitness test at school where he completed 43 laps. While Connor did not seem particularly distraught about his chest’s appearance during his initial visit to CHoR, Dr. Yeh noted the teen seemed happier with his post-surgery looks as well.
“I think pectus excavatum is an undertreated problem,” said Dr. Yeh. “I’ve treated patients in their 40s who couldn’t walk a city block. When I ask them why didn’t get it fixed, they said they were told it was cosmetic, or there was nothing that could be done. My preference is to see kids as soon as a deformity is noticed. Not everyone needs surgery so we just follow along. It’s so gratifying taking care of these kids.”