The utility of echocardiography and pulmonary function testing in the preoperative evaluation of pectus excavatum

Ganescu, Olivia; LaRusso, Kathryn; St-Louis, Etienne; Saint‐Martin, Christine; Cavallé‐Garrido, Tíscar; Zielinski, David; Laberge, Jean-Martin; Emil, Sherif

doi:10.1016/j.jpedsurg.2021.12.010

Cited by 10 publications

(10 citation statements)

References 17 publications

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“…It is estimated that PFTs are abnormal in about 20–25% of pectus patients [ 21 , 37 , 38 ]. In a large study that looked at respiratory function in 1342 primary school students, 35 of which had pectus excavatum, PFT results were normal in 87.9% of the controls versus 68.6% in those with pectus excavatum [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Oftentimes, static PFTs obtained when the patient is at rest are entirely normal in pectus patients, and abnormalities are only identified during times of physiological stress such as exercise [ 39 ]. Unless concordant cardiopulmonary exercise testing is performed, the role of obtaining static PFTs at all has been appropriately questioned [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary function testing (PFT) is a commonly used perioperative modality to assess the lung volumes and flows of these patients before and after repair [ 6 , 13 – 20 ]. While routinely obtained at many centers, critics have suggested PFTs do not accurately represent exercise tolerance and their utility has been questioned [ 20 , 21 ]. A recent study found very little correlation with cardiopulmonary testing including PFTs with patient-reported symptoms and concluded that routine PFT testing is generally not recommended in asymptomatic patients and should be reserved for symptomatic patients with the most severe depressions [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…While routinely obtained at many centers, critics have suggested PFTs do not accurately represent exercise tolerance and their utility has been questioned [ 20 , 21 ]. A recent study found very little correlation with cardiopulmonary testing including PFTs with patient-reported symptoms and concluded that routine PFT testing is generally not recommended in asymptomatic patients and should be reserved for symptomatic patients with the most severe depressions [ 21 ]. These tests are still routine at many centers across the country because insurance companies often require proof of impaired pulmonary function when assessing coverage for this patient population [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent study found very little correlation with cardiopulmonary testing including PFTs with patient-reported symptoms and concluded that routine PFT testing is generally not recommended in asymptomatic patients and should be reserved for symptomatic patients with the most severe depressions [ 21 ]. These tests are still routine at many centers across the country because insurance companies often require proof of impaired pulmonary function when assessing coverage for this patient population [ 21 ]. If preoperative PFTs lack clinical utility or consistency across this patient population, they could represent an extra cost and burden for these patients and our healthcare system.…”

Section: Introductionmentioning

confidence: 99%

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(F)utility of preoperative pulmonary function testing in pectus excavatum to assess severity

Gonzalez,

Berazaluce,

Jenkins

et al. 2024

Pediatr Surg Int

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Purpose The utility of pulmonary function testing (PFT) in pectus excavatum (PE) has been subject to debate. Although some evidence shows improvement from preoperative to postoperative values, the clinical significance is uncertain. A high failure-to-completion rate for operative PFT (48%) was identified in our large institutional cohort. With such a high non-completion rate, we questioned the overall utility of PFT in the preoperative assessment of PE and sought to evaluate if other measures of PE severity or cardiopulmonary function could explain this finding. Methods Demographics, clinical findings, and results from cardiac MRI, PFT (spirometry and plethysmography), and cardiopulmonary exercise tests (CPET) were reviewed in 270 patients with PE evaluated preoperatively between 2015 and 2018. Regression modeling was used to measure associations between PFT completion and cardiopulmonary function. Results There were no differences in demographics, symptoms, connective tissue disorders, or multiple indices of pectus severity and cardiac deformation in PFT completers versus non-completers. While regression analysis revealed higher RVEF, LVEF, and LVEF-Z scores, lower RV-ESV/BSA, LV-ESV/BSA, and LV-ESV/BSA-Z scores, and abnormal breathing reserve in PFT completers vs. non-completers, these findings were not consistent across continuous and binary analyses. Conclusions We found that PFT completers were not significantly different from non-completers in most structural and functional measures of pectus deformity and cardiopulmonary function. Inability to complete PFT is not an indicator of pectus severity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%