Impairment of Cardiac Function in Patients with Pectus Excavatum, with Improvement after Operative Correction

Beiser, G. David; Epstein, Stephen E.; Stampfer, Morris; Goldstein, Robert E.; Noland, Stanton P.; Levitsky, Sidney

doi:10.1056/nejm197208102870602

Cited by 131 publications

(42 citation statements)

References 9 publications

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“…BEISER et al [15] demonstrated cardiac output to be reduced during exercise in some subjects with pectus deformities. But we found no evidence for this in the present study.…”

Section: Discussionmentioning

confidence: 98%

The upper limit of alveolar capillary recruitment in a young man with lung growth impairment

Donnelly¹,

Daxini²,

Bye³

1994

Eur Respir J

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T Th he e u up pp pe er r l li im mi it t o of f a al lv ve eo ol la ar r c ca ap pi il ll la ar ry y r re ec cr ru ui it tm me en nt t i in n a a y yo ou un ng g m ma an n w wi it th h l lu un ng g g gr ro ow wt th h i im mp pa ai ir rm me en nt t P.M. Donnelly*, B.V. Daxini**, P.T.P. Bye* ABSTRACT: In order to obtain further insight into the adaptive mechanisms relating to gas exchange in anatomically small lungs, tests of mechanical lung function and gas exchange were made in an active young man, whose lung growth had been severely impaired due to pectus excavatum developed in childhood. We found our patient to have small (total lung capacity, 59% of predicted) but mechanically normal lungs. He had a normal cardiac output, a normal single-breath diffusing capacity (100% pred), and a high diffusion coefficient (148% pred) associated with a high pulmonary capillary blood volume (131% pred) at rest. Pulmonary distensibility (K) and elastic recoil were normal. During steady-state exercise he was unable to recruit further reserves of pulmonary capillaries, but this was not reflected in a plateau for oxygen consumption, which was presumably the result of an increased pulmonary capillary blood flow rather than volume. The recruitment of pulmonary capillary reserves in this young man has enabled him to maintain a normal maximum exercise capacity. In addition, the high stroke volume and a haemoglobin level in the high normal range (176 g·l -1 ) may have maintained his maximal exercise function, despite fewer alveolar units.This study suggests that, contrary to previous findings, loss of a major proportion of lung tissue need not impair exercise capacity. Patients with either small lungs or following pneumonectomy may benefit from physical training sufficient to optimize both an increase in cardiac output and recruitment of their existing alveolar capillary reserves.

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“…BEISER et al [15] demonstrated cardiac output to be reduced during exercise in some subjects with pectus deformities. But we found no evidence for this in the present study.…”

Section: Discussionmentioning

confidence: 98%

The upper limit of alveolar capillary recruitment in a young man with lung growth impairment

Donnelly¹,

Daxini²,

Bye³

1994

Eur Respir J

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“…9 Studies conducted almost three decades ago using cardiac catheterization before and after pectus repair showed significant improvement in stroke volume and cardiac output. 10 Using cycle ergometry testing, Cahill et al 11 showed that children with severe pectus deformities had an abnormally elevated work of breathing, and that there was a significant improvement in maximum oxygen uptake and total exercise time in 16 children tested before and after repair. A comprehensive review of many published reports indicating improvement in cardiac or respiratory function after pectus repair is provided by Shamberger and Welch.…”

Section: Discussionmentioning

confidence: 99%

Repair of Pectus Excavatum Deformities: 30 Years of Experience With 375 Patients

2000

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“…Only three studies (5,17,28) presented a quantitative measurement of daily activity level before and after surgery and showed no difference in physical fitness throughout the study period in accordance to this. Other studies (14,20,(22)(23)(24)(25)33) reported the perceived exercise tolerance, which does not say much about the actual level of daily activity. Still, they all reported significant improvement, supporting the general knowledge that patients have subjective improvements of ability to perform physical activity.…”

Section: Cardiac Function During Exercisementioning

confidence: 95%

Improved cardiac function and exercise capacity following correction of pectus excavatum: a review of current literature

Maagaard

Heiberg

2016

Ann. Cardiothorac. Surg.

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Patients with pectus excavatum (PE) often describe improvements in exercise stamina following corrective surgery. Studies have investigated the surgical effect on physiological parameters; still, no consensus has yet been reached. Therefore, the aim of this literature review was to describe the cardiac outcome after surgical correction, both at rest and during exercise. In February 2016, a detailed search of the databases PubMed, Medline, and EMBASE was performed. We assessed clinical studies that described cardiac outcomes both before and after surgical correction of PE. We only included studies reporting either pre-defined echocardiographic or exercise test parameters. No exclusion criteria or statistical analyses were applied.Twenty-one full-text articles, published between 1972 and 2016, were selected, with cohort-ranges of 3-168 patients, mean age-ranges of 5-33 years, and mean follow-up-ranges from immediately to 4 years after surgery. Twelve studies described resting cardiac parameters. Four studies measured cardiac output, where one described 36% immediate increase after surgery, one reported 15% increase after Nuss-bar removal and two found no difference. Three studies demonstrated improvement in mean stroke volume ranges of 22-34% and two studies found no difference. Fifteen studies investigated exercise capacity, with 11 considering peak O 2 pr. kg, where five studies demonstrated improvements with the mean ranging from 8% to 15% after surgery, five studies demonstrated no difference, and one saw a decrease of 19% 3 months after Nuss-bar implantation. A measurable increase in exercise capacity exists following surgery, which may be caused by multiple factors. This may be owed to the relief of compressed cardiac chambers with the increased anteriorposterior thoracic dimensions, which could facilitate an improved filling of the heart. With these results, the positive physiological impact of the surgery is emphasized and the potential gain in cardiac function should be integrated in the clinical assessment of patients with PE.

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Impairment of Cardiac Function in Patients with Pectus Excavatum, with Improvement after Operative Correction

Cited by 131 publications

References 9 publications

The upper limit of alveolar capillary recruitment in a young man with lung growth impairment

The upper limit of alveolar capillary recruitment in a young man with lung growth impairment

Repair of Pectus Excavatum Deformities: 30 Years of Experience With 375 Patients

Improved cardiac function and exercise capacity following correction of pectus excavatum: a review of current literature

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