Cardiopulmonary effects of closed repair of pectus excavatum☆
Section snippets
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.