Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum

Abstract

BackgroundPectus excavatum (PE) and pectus carinatum (PC) have generally been considered an aesthetic issue, although there is growing evidence of associated cardiopulmonary function (CPF) impairment, especially in PE patients. The study goal was to determine any correlation between pectus malformations and cardiopulmonary symptoms and function based on systematic assessment of CPF and thoracic measurements, such as Haller Index (HI) and sternal torsion angle (STA).MethodsData from 76 adolescent patients with PE (n=30) or PC (n=46) were retrospectively collected referred between January 2015 and April 2018. CPF measurements and thoracic imaging were performed in all patients. HI and STA correction indexes were measured in all patients.FindingsMedical records from 76 patients (PE n=30; PC n=46) were analysed. Patients were predominantly male (>93.3%), and aged between 13 and 14½ old. PE was associated with airway obstruction, with a forced expiratory volume in 1 s value under the lower limit of normal in 13% of cases (p<0.001). Restrictive syndrome was observed in 23% of cases (p<0.001), with a Z score for total lung capacity under the lower limit of normal. In PC, pulmonary function was not affected. All patients showed slightly decreased values of left and right ejection fraction and cardiac index at rest, although values were within normal range. There were no significant correlations between pulmonary and cardiac functions or between low CPF and thoracic measurements.InterpretationOur results confirm the modest impact of pectus malformations on CPF at rest, without correlation with anamnestic dyspnoea on exertion, nor with chest pain or anatomical measurements. Validation of new correction indexes could be helping characterise these malformations and choose optimal therapeutic management.

Is there a relationship between Haller Index and cardiopulmonary function in children with pectus excavatum?

“…[19] In another study, low lung volumes were found in 23% of PE patients. [16] Consistent with the literature, in our patient group, the FVC and FEV1 values were found to be below normal in Groups 2 and 3. In our study, the values of FEV1 and FVC statistically significantly decreased, as the HI increased.…”

“…[7] In a large-volume study in the literature, 62% reported dyspnea and 32% had chest pain at rest. [15] In a recent study by Ramadan et al, [16] 13.3% of patients reported dyspnea while exercising and 20% reported chest pain at rest. The most common complaints in our study were chest pain and shortness of breath, particularly with exercise.…”

Clinical significance of concomitant pectus deformity and adolescent idiopathic scoliosis: systematic review with best evidence synthesis

“…One study was identified by backward citation. Eventually, 48 studies were included: 19 in category I [ 5 , 9 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] ], 21 in category II [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , and 8 in category III [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] ( Figure 1 ).

Figure 1 PRISMA 2020 flow diagram of identification, screening, and inclusion of papers in the 3 categories.

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“…Combining categories I and II, 31 studies reported a prevalence of scoliosis in PD populations (Appendix C). In all, 19 comprised solely PE cases [ 18 , 19 , [21] , [22] , [23] , 26 , 30 , 31 , 34 , 36 , [38] , [39] , [40] , [41] , [42] , 45 , 47 , 49 , 50 ], 2 solely PC cases [ 35 , 44 ], and 6 analyzed PE and PC separately [ 5 , 16 , 35 , 43 , 46 , 51 , 52 ]. Fourteen studies described definitions of scoliosis or its diagnostic measures [ 5 , 18 , 19 , 22 , 23 , 26 , 30 , 31 , 33 , 34 , 40 , 47 , 52 , 53 ], 9 involved an entire idiopathic population [ 16 , 19 , 22 , 26 , 30 , 31 , 34 , 41 , 51 , 52 ], and 1 a non-surgical one [53] .…”

Hiatus hernia repair in the setting of pectus excavatum: an impossible combination!

“…2 Patients may also have a reduced forced vital capacity and forced expiratory volume with the potential for right heart failure. 3 Surgical correction of pectus excavatum is invasive and painful, involving the insertion of a substernal titanium bar. 2 Treatment is generally reserved for younger patients, as well as those with severe cardiac or respiratory compromise.…”