Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure.

BACKGROUND/PURPOSE Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs) in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal. METHODS The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson's equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100% of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV1), and forced expiratory flow (FEF25%-75%). RESULTS Preoperatively, FVC and FEV1 medians were lower than the normal by 13%, whereas the FEF 25-75 median was lower than normal by 20% (all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean post-bar removal improvement than the younger patients. An older patient with a preoperative FEF25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF25-75 of 97%, indicating almost complete normalization for this function. CONCLUSIONS These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.

[1]  Donald Nuss,et al.  A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. , 2003, Journal of pediatric surgery.

[2]  M. Stampfer,et al.  Impairment of cardiac function in patients with pectus excavatum, with improvement after operative correction. , 1972, The New England journal of medicine.

[3]  R. Shamberger.  Cardiopulmonary effects of anterior chest wall deformities. , 2000, Chest surgery clinics of North America.

[4]  M M Ravitch,et al.  THE OPERATIVE TREATMENT OF PECTUS EXCAVATUM , 1949, Annals of surgery.

[5]  M. E. Katz,et al.  A 10-year review of a minimally invasive technique for the correction of pectus excavatum. , 1998, Journal of pediatric surgery.

[6]  N. Barrett.  The chest wall. , 1958, Annals of the Royal College of Surgeons of England.

[7]  R. Shamberger.  Congenital chest wall deformities. , 1996, Current problems in surgery.

[8]  S. Robbins,et al.  Pathologic basis of disease , 1974 .

[9]  S. Barcikowski,et al.  Cardiorespiratory function before and after operation for pectus excavatum: medium-term results. , 1998, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[10]  J. Mead,et al.  Rib cage mobility in pectus excavatum. , 1985, The American review of respiratory disease.

[11]  M. Feinberg,et al.  Why is exercise capacity reduced in subjects with pectus excavatum? , 2000, The Journal of pediatrics.

[12]  D. Driscoll,et al.  Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation. , 1990, The Journal of thoracic and cardiovascular surgery.

[13]  Christopher B Cooper,et al.  Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. , 2003, Chest.

[14]  G. Loughlin,et al.  Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines. , 2000, The Journal of cardiovascular surgery.

[15]  M. Debakey,et al.  CHŌNĒ-CHONDROSTERNON: Report of a Case and Review of the Literature , 1939 .

[16]  R. White.  Microscopic Organisms in Cochituate Water , 1878 .

[17]  Donald Nuss,et al.  Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. , 2002, Journal of pediatric surgery.