Exercise Cardiac Output Limitation in Pectus Excavatum

Tardy, Marie M.; Filaire, Marc; Patoir, Arnaud; Gautier-Pignonblanc, Pierre; Galvaing, Géraud; Kwiatkowski, Fabrice; Costes, Frédéric; Richard, Ruddy

doi:10.1016/j.jacc.2015.06.1087

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…5 A study found that during exercise, patients with PE were unable to reach the stroke volumes of control patients at any intensity of exercise. 32 Accordingly, cardiac output was decreased, which led to a limitation in peak exercise capacity. 32 Exercise ability and maximum Vo 2 have been shown in some studies to be statistically significantly improved after repair of PE.…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

See 1 more Smart Citation

Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

Abid¹,

Ewais²,

Marranca³

et al. 2017

Journal of Osteopathic Medicine

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Osteopathic medicine places a special emphasis on the musculoskeletal system, and understanding how chest wall structure may influence function is critical. Pectus excavatum is a common congenital chest wall defect in which the sternum is depressed posteriorly. Patients may present with complaints of chest wall discomfort, exercise intolerance, and tachycardia. The medical implications, diagnosis, and treatment options for patients with pectus excavatum are reviewed.

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Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

“…32 Accordingly, cardiac output was decreased, which led to a limitation in peak exercise capacity. 32 Exercise ability and maximum Vo 2 have been shown in some studies to be statistically significantly improved after repair of PE. 5,33…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

Pectus Excavatum: A Review of Diagnosis and Current Treatment Options

Abid¹,

Ewais²,

Marranca³

et al. 2017

Journal of Osteopathic Medicine

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“…Deconditioning is reported in 10-23% of adolescents with dyspnea and may be a significant contributing factor to dyspnea in pectus 38,39 . However several reports demonstrated cardiac filling in pectus is reduced in some patients as a result of compression by the displaced sternum on the right heart chambers or torqueing of the great vessels, thereby constraining increases in cardiac output during vigorous exercise [3][4][5]40 . Limitations of CPET in identifying precise mechanisms for exercise intolerance include specific response patterns are rarely pathognomonic and indirectly informative regarding the central hemodynamic responses to exertion.…”

Section: Discussionmentioning

confidence: 99%

“…The mechanisms leading to the symptom burden in pectus patients are currently unclear. Many investigators propose the exercise intolerance in pectus is directly related to compromise in the cardiovascular response from the anatomic distortion of the chest wall [3][4][5] . In more extensive cases of pectus, the internally displaced chest wall may compress the lungs and may reduce resting lung volumes.…”

Section: Introductionmentioning

confidence: 99%

Ventilatory limitations are not associated with dyspnea on exertion or reduced aerobic fitness in pectus excavatum

Hardie

Powell

Jenkins

et al. 2021

Preprint

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Pulmonary defects are reported in pectus excavatum but the physiological impact on exercise capacity is unclear. To test the hypothesis that pectus deformities are associated with a pulmonary impairment during exercise we performed a retrospective review on pectus patients in our center who completed a symptom questionnaire, cardiopulmonary exercise test, pulmonary function tests (PFT), and chest magnetic resonance imaging. Of 259 patients studied, dyspnea on exertion and chest pain was reported in 64% and 41% respectively. Peak oxygen uptake (VO2) was reduced in 30% and classified as mild in two-thirds. A pulmonary limitation during exercise was identified in less than 3%. Ventilatory limitations on PFT was found in 26% and classified as mild in 85%. Obstruction was the most common abnormal pattern (11%) followed by a nonspecific ventilatory limitation and restrictive pattern (7% each). There were no differences between patients with normal or abnormal PFT patterns for the anatomic degree of pectus malformation, VO2, or percentage reporting dyspnea or chest pain. Scatter plots demonstrated significant inverse relationships between severity of the pectus deformity with lung volumes on PFT and VO2 but no correlation between the severity of the pectus deformity and lung volumes during exercise. We conclude that resting lung volume measurements were associated with the anatomic degree of pectus severity but respiratory limitations during maximal exercise are uncommon and PFT patterns have poor correlation with symptomatology or VO2. These findings suggest non-respiratory causes are more likely for the high rates of dyspnea and reduced aerobic fitness reported in pectus.

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“…It consists of an overgrowth of the chondral region with posterior displacement of the inferior part of the sternum, resulting in a concave chest deformity [1], [2]. Although PEXT is viewed as a benign condition with mainly cosmetic interest, characteristic clinical and imaging findings may occur, depending on the compression that right cardiac chambers suffer, when squeezed between the sternum and the column vertebrae [3], [4].…”

mentioning

confidence: 99%