Pulmonary function before and after the Nuss procedure in adolescents with pectus excavatum: correlation with morphological subtypes

Abstract

BackgroundDifferences in post-Nuss procedure pulmonary function based on the pectus excavatum subtype have not been investigated in adolescents. We evaluated differences in pulmonary function before and after the Nuss procedure according to preoperative morphology.MethodsWe performed a retrospective review of eighteen male patients who had undergone the Nuss procedures. There were nine patients each with symmetric and asymmetric morphology. Patients were younger than 18 years and had no history of respiratory diseases. Pulmonary function was assessed 2 weeks before and 4–6 months after the surgery. Preoperative and postoperative pulmonary function data were compared between the symmetric and asymmetric types. The paired t-test was used to compare the differences within each group and an analysis of covariance (ANCOVA) was used to access intergroup differences.ResultsThere were no significant demographic differences between patients with symmetric and asymmetric subtypes. Patients with the asymmetric type had a lower preoperative total lung capacity (TLC) (p = 0.018), vital capacity (VC) (p = 0.0308), and inspiratory capacity (IC) (p = 0.0373). In both types, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and VC were all significantly decreased postoperatively compared to baseline (all, p < 0.01). The asymmetric type showed further reductions in peak expiratory flow (PEF) (p = 0.0391) and IC (p = 0.0084) postoperatively. The residual volume (RV) (p = 0.0092) and RV/TLC ratio (p = 0.0025) increased significantly in the asymmetric type, but only the postoperative PEF values differed significantly between the two types (p = 0.0151).ConclusionsThe asymmetric type had poorer preoperative lung volumes and poorer postoperative pulmonary function, with significantly lower PEF compared to the symmetric type cases. Preoperative and postoperative lung function needs more careful evaluation until pectus bar removal in the asymmetric type of pectus excavatum.

Nuss procedure for pectus excavatum in adults: long-term results in a prospective observational study

“…Further studies focusing on the physical condition of patients in the longterm follow-up are needed. It is not entirely clear whether the improvement in exercise tolerance in the postoperative course, which is often described by the patients and which has also been documented by other authors, is due to a real improvement in cardiopulmonary function or merely to the fact that patients with a corrected deformity are more readily willing to participate in sports [14,15]. In the present study's preoperative cardiopulmonary work-up, no significant respiratory problems were identified that were directly associated with the chest wall deformity or could explain the symptoms the patients reported in preoperative interviews.…”

Changes in thoracic cavity dimensions of pectus excavatum patients following Nuss procedure

“…Sigalet et al (5) measured reduced dynamic pulmonary function, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1 ), and vital capacity (VC) following Nuss repairs of PE. Jeong et al (19) also reported significantly decreased FVC, FEV 1 , and VC values after the Nuss procedure in adolescents with PE. These authors thought that this reduced pulmonary function was due to short period for steel strut reshaping of the chest wall (5,20).…”

Thoracic cavity remodeling and pulmonary function change after chest wall resection

“…These results may be related to the morphological asymmetry of the thoracic cavity. Jeong et al ’s study with adolescents treated with the Nuss procedure reported that the reduction of peak expiratory flow and inspiratory cavity was more prominent in patients with the asymmetric type ( 18 ). According to the Blickman et al ’s study, addressing asymmetry in patients with pectus excavatum can improve the pulmonary ventilation-perfusion ratio ( 19 ).…”