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

  • M. Louise Lawson
    Correspondence
    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.
    Affiliations
    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
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  • Robert B. Mellins
    Affiliations
    Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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  • Meredith Tabangin
    Affiliations
    Center for Pediatric Research, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, VA 23507, USA
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  • Robert E. Kelly Jr.
    Affiliations
    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
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  • Daniel P. Croitoru
    Affiliations
    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
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  • Michael J. Goretsky
    Affiliations
    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
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  • Donald Nuss
    Affiliations
    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
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      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 (FEF25%-75%).

      Results

      Preoperatively, FVC and FEV1 medians were lower than the normal by 13%, whereas the FEF25-75 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 FEF25-75 score of 80% of normal would be predicted by these data to have a postoperative FEF25-75 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.

      Index words

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      References

      1. Ravitch MM. The Chest Wall. In: Welch KJ, Randolph JG, Ravitch MM, et al, editors. Pediatric Surgery. 4th ed. Chicago, IL: Year Book Medical; 568-78.

        • Nuss D.
        • Kelly Jr., R.E.
        • Croitoru D.P.
        • et al.
        A 10-year review of a minimally invasive technique for the correction of pectus excavatum.
        J. Pediatr. Surg. 1998; 33: 545-552
        • Beiser G.
        • Epstien S.E.
        • Stampfer M.
        • et al.
        Impairment of cardiac function in patients with pectus excavatum with improvement after operative correction.
        N. Engl. J. Med. 1972; 99: 41-47
        • Lawson M.L.
        • Cash T.F.
        • Akers R.A.
        • et al.
        A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum.
        J. Pediatr. Surg. 2003; 38: 916-918
        • Croitoru D.
        • Kelly R.
        • Goretsky M.
        • et al.
        Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients.
        J. Pediatr. Surg. 2002; 37: 437-445
        • Knudson R.J.
        • Lebowitz M.D.
        • Holberg C.J.
        • et al.
        Am. Rev. Respir. Dis. 1983; 127: 725-734
        • Ochsner A.
        • DeBakey M.
        Chone-chondrosternon: report of a case and review of the literature.
        J. Thorac. Surg. 1939; 8: 469-511
        • Robbins S.L.
        • Cotran R.S.
        Pulmonary obstructive disease.
        Pathologic Basis of Disease. 2nd ed. W.B. Saunders, Philadelphia (PA)1979
        • Wynn S.R.
        • Driscoll D.J.
        • Ostrom N.K.
        • et al.
        Exercise cardiorespiratory function in adolescents with pectus excavatum.
        J. Thorac. Cardiovasc. Surg. 1990; 99: 41-47
        • Kowalewski J.
        • Barcikowski S.
        • Brocki M.
        Cardiorespiratory function before and after operation for pectus excavatum: medium-term results.
        Eur. J. Cardiothorac. Surg. 1998; 13: 275-279
        • Ravitch M.M.
        The chest wall.
        in: Welch K.J. Randolph J.G. Ravitch M.M. Pediatric Surgery. 4th ed. Year Book Medical, Chicago (IL)1989: 568-578
        • Ravitch M.M.
        The operative treatment of pectus excavatum.
        Ann. Surg. 1949; 129: 429-444
        • Shamberger R.C.
        Congenital chest wall deformities.
        Curr. Probl. Surg. 1996; 23: 471-542
        • Haller J.A.
        • Loughlin G.M.
        Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum.
        J. Cardiovasc. Surg. 2000; 41: 125-130
        • Zhao L.
        • Feinberg M.
        • Gaides M.
        • et al.
        Why is exercise capacity reduced in subjects with pectus excavatum?.
        J. Pediatr. 2000; 136: 163-167
        • Mead J.
        • Sly P.
        • LeFouef P.
        • et al.
        Rib cage mobility in pectus excavatum.
        Am. Rev. Respir. Dis. 1985; 132: 1223-1228
        • Shamburger R.C.
        Cardiopulmonary effects of anterior chest wall deformities.
        Chest Surg. Clin. N. Am. 2000; 10: 245-252
        • Malek M.H.
        • Fonkalsrud E.W.
        • Cooper C.D.
        Ventilatory and cardovascular reponses to exercise in patients with pectus excavatum.
        Chest. 2003; 124: 870-882