Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure

Lawson, M. Louise; Mellins, Robert B.; Tabangin, Meredith; Kelly, Robert E.; Croitoru, Daniel P.; Goretsky, Michael J.; Nuss, Donald

doi:10.1016/j.jpedsurg.2004.09.040

« Previous Next »Journal of Pediatric Surgery
Volume 40, Issue 1 , Pages 174-180, January 2005

Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure

Presented at the 35th Annual Meeting of the American Pediatric Surgical Association, Ponte Vedra, Florida, May 27-30, 2004.

M. Louise Lawson
- Center for Pediatric Research, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA 23507, USA
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
- Corresponding author. Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. Tel.: +1 513 636 1376; fax: +1 513 636 7509.
Robert B. Mellins
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
Meredith Tabangin
- Center for Pediatric Research, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA 23507, USA
Robert E. Kelly Jr.
- Department of Pediatric Surgery, Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA
Daniel P. Croitoru
- Department of Pediatric Surgery, Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA
Michael J. Goretsky
- Department of Pediatric Surgery, Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA
Donald Nuss
- Department of Pediatric Surgery, Children's Hospital of The King's Daughters, Norfolk, VA 23507, USA
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA

Abstract

Background/Purpose

Patient reports of preoperative exercise intolerance and improvement after surgical repair of pectus excavatum (Pex) have been documented but not substantiated in laboratory studies. This may be because no study has been large enough to determine if pulmonary function tests (PFTs) in the Pex population are significantly different from the normal population, and none has assessed improvement in pulmonary function after Nuss bar removal.

Methods

The authors studied PFT results in 408 Pex patients before repair and in a subset of 45 patients after Nuss procedure and bar removal. Significance of differences in percent predicted (using Knudson's equations) was tested using t tests (parametric) or sign tests (nonparametric). Normal was defined as 100% of predicted for forced vital capacity (FVC), forced expired volume in 1 second (FEV₁), and forced expiratory flow (FEF_25%-75%).

Results

Preoperatively, FVC and FEV₁ medians were lower than the normal by 13%, whereas the FEF_25-75 median was lower than normal by 20% (all P < .01). The postoperative group had statistically significant improvement after surgery for all parameters. Patients older than 11 years at the time of surgery had lower preoperative values and larger mean post–bar removal improvement than the younger patients. An older patient with a preoperative FEF_25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF_25-75 of 97%, indicating almost complete normalization for this function.

Conclusions

These results demonstrate that preoperatively Pex patients as a group have decreased lung function relative to normal patients. After Nuss procedure and bar removal, we show a small but significant improvement in pulmonary function. These results are consistent with patient reports of clinical improvement and indicate the need for more in-depth tests of cardiopulmonary function under exercise conditions to elucidate the mechanism.