Degree of severity of pectus excavatum and pulmonary function in preoperative and postoperative periods

Upper thoracic shape in children with pectus excavatum: Impact on lung function

“…This is due in part to the few patients with extreme deformities in our series. Kaguraoka et al3 found a higher correlation between PSI and VC (r = 0.61) but 28% of the 138 patients in their series had a PSI >8. Quigley et al6 also reported higher correlation coefficients than in our results but only when comparing PSI to total lung capacity and functional residual capacity rather than VC.…”

“…Alternatively, two of the following features have been suggested as criteria for surgical repair: a PSI of >3.25; history of a progressive deformity, compression or displacement of the heart by echocardiogram, or CT scan, lung function suggesting restrictive disease, mitral valve prolapse, right bundle branch block on electrocardiogram, and history of a failed surgical repair of the PE 14. The use of the combinations of abnormalities exists in part because of the crude correlation between the structural severity and the functional abnormalities associated with the PE 3, 5, 6. Our report suggests that the PGI, in conjunction with the PSI, is more informative than the PSI alone and that in the absence of a PG, the PSI alone does not predict loss of lung function.…”

“…Although it is considered a cosmetic deformity by some, a subgroup of children present with clinical concerns of exercise intolerance, fatigue, dyspnea of exertion, or chest pain. Among children with PE who are old enough to perform lung functions, both restrictive and obstructive lung disease have been reported 3–6. Severity of the PE is determined by both cardiopulmonary functions and also imaging of the chest wall.…”

“…The Pectus Severity Index (PSI) or Haller Index utilizes axial images of the thorax on CT scans to determine a chest wall width to depth ratio where sternal intrusion into the chest is deepest 7. Although the PSI measures severity of the structural deformity, PSI only modestly correlates with lung function measurements 3, 5, 6. We postulate that another feature of the thorax in children with PE exists that also influences lung function.…”

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“…Os testes de função pulmonar mostram poucas alterações devido a vários fatores, como grandes variações do normal; vários métodos de aferição; tolerância aos exercícios e utilização de tabelas de populações normais para comparação com o indivíduo submetido aos testes. Kaguraoka encontrou média da capacidade vital de 86,1% e do volume expiratório forçado em um segundo (VEF 1 ) de 85,5%, e um decréscimo de 10% no pós-operatório de dois meses, com retorno aos níveis pré-operatórios em um ano, sem melhora da capacidade vital até 42 meses de pósoperatório 23 . Dato não encontrou diferença significativa pré e pós-operatória em relação à função pulmonar 5 .…”