Impact of surgical treatment of pectus carinatum on cardiopulmonary function: a prospective study

Abstract

OBJECTIVES The frequency of sternochondroplasty in cases of pectus carinatum (PC) has increased due to greater surgeon experience and modified surgical techniques. PC deformity does not usually cause cardiopulmonary malfunction or impairment. However, whether cardiopulmonary function changes after surgical repair remains a matter of controversy. The aim of our prospective study was to determine if surgery changes preoperative cardiopulmonary function. METHODS Nineteen patients (16 males, 3 females) were enrolled in a prospective, open-label, single-arm, single-centre clinical trial (Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Function) (NCT02163265) between July 2013 and January 2017. All patients underwent PC repair via a modified Ravitch procedure and wore a lightweight, patient-controlled chest brace for 8 weeks postoperatively (the Innsbruck protocol). The average follow-up surgical examination was 8.3 months after surgery. In all enrolled patients, before surgery and not before 6 months postoperatively chest X-ray, 3-dimensional volume-rendered computed tomography thorax imaging, cardiopulmonary function tests with stepwise cycle spiroergometry (sitting and supine position) and Doppler echocardiography were performed; questionnaires about daily physical activity were also completed. RESULTS Fourteen patients (aged 16.3 ± 2.6 years at study entry) completed the study. Changes in submaximal and peak power output were not detected during sitting, or when in the supine position. Also, no clinically relevant postoperative changes in spirometry or echocardiography were noted. CONCLUSIONS Our findings confirm that surgical correction of PC does not impair cardiopulmonary function at rest or during physical exercise. Clinical registration number clinicaltrials.gov NCT02163265.

The management of pectus excavatum in pediatric patients: a narrative review

“…In a subset of 66 patients who underwent PFTs prior to surgical repair and one year after bar removal, there were significant improvements in median FVC (88% to 92% of predicted) and FEV 1 (83 to 88% of predicted) (11). This improvement in function has not been consistently demonstrated in the literature, including a meta-analysis of 12 studies that failed to show a statistically significant change in pulmonary function, or in a recent prospective study that also included cardiopulmonary exercise testing and echocardiography (12,13).…”

Bracing of Pectus Carinatum in Children: Current Practices

“…This deformity has been referred to as "undertreated chest wall deformity" due to infrequent referrals from primary care practitioners and probable underestimation of its frequency [2,3]. PC rarely causes cardiopulmonary symptoms, but mostly adolescent patients experience shame and embarrassment resulting in low self-confidence and therefore seeking treatment [4,5].…”

The Role of Anthropologic Measurements in Pectus Carinatum Brace Treatment Evaluation

“…Despite being a congenital malformation, it most often manifests itself clinically at a later age (typically -preschool or at the onset of puberty), and tends to worsen with age [4], [5]. Boys are affected 4 to 5 times more often than girls [6]. The exact aetiology is still unknown, although it is considered to result from abnormal idiopathic rib cartilage growth, causing an anterior chest wall protrusion of varying severity [3].…”