Cardiopulmonary effects of closed repair of pectus excavatum

Presented at the 33rd Annual Meeting of the American Pediatric Surgical Association, Phoenix, Arizona, May 19-23, 2002.
https://doi.org/10.1053/jpsu.2003.50112Get rights and content

Abstract

Background/Purpose: Increasing numbers of patients with pectus excavatum defects are presenting for operative repair. Studies that follow-up with patients after open repair have found a decrease in pulmonary function with some improvement in cardiac output and exercise tolerance; however, these effects have not been examined systematically after closed or Nuss repair of pectus excavatum. This study examined the early postoperative effects of closed repair of pectus on pulmonary function, exercise tolerance, and cardiac function. Methods: Patients were followed up prospectively after initial evaluation for operation. All patients underwent preoperative computed tomography (CT) scan, and pre- and postoperative (3 months) pulmonary function studies, exercise tolerance, and echocardiographic evaluation of cardiac function. Results: Eleven patients underwent evaluation. Preoperative CT index was 4.1 ± 0.9. Patients reported an improvement in subjective postoperative exercise tolerance (4.1 ± 0.7; maximal, + 5). Pulmonary function studies (FVC and vital capacity) were significantly reduced at 3 months postsurgery: change in FVC, −0.67 ± 0.92 L and VC, −0.5 ± 0.72 L. Similarly, VO2 max was reduced: preoperative, 35.6 ± 1.5 versus postoperative, 29.1 ± 11.9 L/kg/min. Cardiac function was significantly improved postoperation (stroke volume preoperative, 61.6 ± 25 versus 77.5 ± 23 mL postoperative). All comparisons had a P value less than.05 by Student's paired t test. Conclusions: These results show that closed repair of pectus excavatum is associated with a subjective improvement in exercise tolerance, which is paralleled by an increase in cardiac function and a decline in pulmonary function. These findings support the use of closed repair of pectus excavatum in patients who complain of subjective shortness of breath; further study is required to delineate the long-term cardiopulmonary implications after closed repair. J Pediatr Surg 38:380-385. Copyright 2003, Elsevier Science (USA). All rights reserved.

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Materials and methods

With the introduction of the closed (Nuss) technique for repair of pectus excavatum at the Alberta Children's Hospital, we developed an institutional algorithm for evaluation of these patients. This included pre and postoperative pulmonary function studies, CT scan, and cardiovascular evaluation. Data were gathered prospectively. Patients were studied preoperatively, at 3 months postoperatively, with planned reviews at 12 to 18 months postoperating (before removal of the pectus bar), and then

Results

A total of 11 patients have completed the evaluation to date. Demographic details are presented in Table 1.All patients underwent closed, thorascopically guided, repair of pectus excavatum as described by Nuss.1 Three patients required replacement of 2 bars. Average days in the hospital after repair was 4.9 ± 1.2. One patient required a rewiring of a lateral stabilizing bar 10 months postoperation. A second patient who had coexisting bronchopulmonary dysplasia had a transient pericarditis

Discussion

These results may provide useful insight into the mechanisms that underlie the subjective complaints of shortness of breath on exertion, which most patients with pectus excavatum report. Our patients universally reported modest to marked improvement in their subjective feelings of shortness of breath after closed repair of their pectus defect (Table 1). However, our results show a surprising pattern of reduction in dynamic pulmonary function (reduced FVC, FEV1, and vital capacity) after

Acknowledgements

The authors thank Gail Wright-Wilson for secretarial assistance, and the Pulmonary Function Lab and Echocardiography Lab at the Alberta Children's Hospital for assistance.

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Address reprint requests to David L. Sigalet, MD, PhD, Department of Surgery, Alberta Children's Hospital, 1820 Richmond Rd SW, Calgary, Alberta, Canada T2T 5C7.

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