Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure
Introduction
Pectus excavatum (Pex) is a birth defect that results in a depression of the sternum and anterior chest. The size and shape of the depression range from mild concave depressions of a few millimeters to severe asymmetrical depressions of several centimeters. Most patients with more than mild Pex have displacement of the lungs and heart, and many report some degree of exercise intolerance or lack of endurance [1], [2]. These patients tend to be round shouldered and have what physicians familiar with this disorder sometimes refer to as the classic pectus posture. In patients with severe depressions, there is clinical evidence that cardiorespiratory function may be impaired. This is usually manifested at the clinical level by mild to moderate exercise intolerance, chest pain with exertion, and recurrent respiratory tract infections [2] and at the laboratory level by decreased pulmonary function and stroke volume [3]. Nevertheless, questions remain about the impact of Pex on pulmonary function and the use of pulmonary function tests (PFTs) in assessing clinical outcomes in patients with Pex. Several factors may account for the apparently contradictory results in the literature including variability of the severity, the extent and nature of the surgical correction, and the age and small number of subjects studied.
After introduction of a minimally invasive procedure for Pex repair by the surgeons in our hospital, we have had a large influx of patients with Pex, many of whom have now had bar removal. We recently reported the results of a pre- and postsurgical survey of 19 patients in which patients and their parents reported significantly improved exercise tolerance after surgical repair of Pex with the Nuss procedure [4]. Patients further reported a decreased incidence of shortness of breath, chest pain, and tiredness. The purpose of the present investigation was to use more objective pulmonary function data from before and after treatment with the Nuss procedure to test the hypotheses that (1) patients with Pex who qualified for surgery (n = 408) have reduced PFTs relative to the normal population and (2) Pex repair results in significant improvement in PFTs after minimally invasive surgical intervention (Nuss procedure) and bar removal (n = 45).
Section snippets
Study population
We examined preoperative repair PFT results from 408 patients who were clinically approved for surgery at Children's Hospital of The King's Daughters (CHKD) in Norfolk, Va, between 1993 and 2003. The population was predominantly male (82%) and white (94%). The median age on the day of the PFT was 13.4 (interquartile range [IQR] 10.0,15.7). Marfanoid characteristics were noted by the surgeon in 24% of the patients, some degree of scoliosis was noted in 28%, and 39% self-reported frequent
Results
Table 1 shows the FVC, FEV1, and FEF25-75 results for the preoperative Pex population. For all 3 parameters, the population was significantly skewed away from normal, as illustrated by the P value in the last column. The 75th percentile for each parameter was below 100%, where in a normal population the 50th percentile would be expected to be near 100% and the 75th percentile would be expected to be above 100%. Tests of location confirm that the population average is significantly different
Discussion
Despite numerous studies of cardiac and pulmonary function in the laboratory over a 50-year period [3], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17] there continues to be uncertainty as to whether the Pex anomaly results in cardiopulmonary abnormalities. Several authors have noted decreases in pulmonary function (primarily vital capacity and airflow rate) among patients with Pex, although the results often fall within the normal range [15], [16], [17], [18]. These findings are
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Changes in Pulmonary Functions of Adolescents with Pectus Excavatum Throughout the Nuss Procedure
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2022, Journal of Pediatric SurgeryCitation Excerpt :We want to again emphasize that our study does not aim to promote any impression that PE has no cardiopulmonary consequences. As mentioned earlier, there is a significant body of literature pointing to cardiopulmonary deficiencies in many patients with PE, particularly those at the severe end of the spectrum [1–10]. Several studies have documented postoperative improvements [2–4].
Preoperative resource utilization prior to minimally invasive repair of pectus excavatum
2021, American Journal of SurgeryCitation Excerpt :Nevertheless, PFTs are still a standard part of preoperative evaluation for MIRPE in many institutions.17–21 This practice is partially due to third-party payor preauthorization requirements, but has also been fueled by findings of higher likelihood of decreased pulmonary function in patients with more severe deformities22 and improvement in lung function following surgical correction of pectus excavatum.17,23 Malek et al. performed a meta-analysis in 2006 which showed no significant improvement in pulmonary function after surgical repair of pectus excavatum.21
Pectus Excavatum and Carinatum
2021, Encyclopedia of Respiratory Medicine, Second EditionChanges in resting pulmonary function testing over time after the Nuss procedure: A systematic review and meta-analysis
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