Effect of Pectus Excavatum Deformity on Cardiorespiratory Fitness in Adolescent Boys

Rowland, Thomas W.; Moriarty, Kevin P.; Banever, Gregory T.

doi:10.1001/archpedi.159.11.1069

Cited by 56 publications

(21 citation statements)

References 23 publications

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“…This is similar to the results reported by Lawson et al [15], and suggests that the closed technique results in a significantly different long term outcome from the classical Ravitch technique. While the results are arguably modest, they do represent a normalization of function that would not be expected to occur without intervention [17].…”

Section: Discussionmentioning

confidence: 70%

“…It is difficult to delineate the specific factors which may have led to this improvement; however, we would argue that it is due to a combination of improved efficiency of ventilation, and increased stroke volume (and secondarily cardiac output) at exercise. The perceived shortness of breath with intense exercise, which patients describe preoperatively is likely due to the reduced stroke volume at load caused by the pectus compression [6,17,19]. In normal subjects, maximal exercise capacity (and the shortness of breath which is the factor usually given as limiting by subjects) is directly correlated with oxygen delivery, which in turn relates primarily to cardiac output [20,21].…”

Section: Discussionmentioning

confidence: 99%

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Long term cardiopulmonary effects of closed repair of pectus excavatum

et al. 2007

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The closed or "Nuss" repair of pectus excavatum is widely accepted for correction of moderate to severe deformities. Patients typically report significant subjective improvements in pulmonary symptoms, and short and medium term evaluations (up to 2 years with the bar in place) suggest modest improvement to cardiac function but a decrease in pulmonary function. This study examined the effects at 3 months post-bar removal of closed repair of pectus on pulmonary function, exercise tolerance and cardiac function. Patients were followed prospectively after initial evaluation for operation. All patients underwent preoperative and post-bar removal evaluation with CT scan, complete pulmonary function and exercise testing to anaerobic threshold, as well as echocardiogram. Twenty-six patients have completed the follow up protocol. Preoperative CT index was 4.5 +/- 1.3, average age at operation was 13.2 years, and average tanner stage was 3.5 +/- 0.5. At 3 months or greater follow-up post-bar removal, patients reported an improvement in subjective ability to exercise and appearance (P < 0.05 by wilcoxin matched pairs). Objective measures of FEV1, total lung capacity, diffusing lung capacity, O(2) pulse, VO(2max), and respiratory quotient all showed significant improvement compared to preoperative values, while normalized values of cardiac index at rest did not (All values normalized for height and age, comparisons P < 0.05 by student's paired t test). These results demonstrate a sustained improvement in cardiopulmonary function after bar removal following closed repair of pectus excavatum. These findings contrast with results from previous studies following the open procedure, or with the closed procedure at earlier time points; the long term physiological effects of closed repair of pectus excavatum include improved aerobic capacity, likely through a combination of pulmonary and cardiac effects.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Long term cardiopulmonary effects of closed repair of pectus excavatum

et al. 2007

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“…Recent studies have shown that patients with PE have impaired cardiorespiratory function compared to control group (3)(4)(5). The impact of these reduced physiological functions is not fully established; however, they may account for the presence and extent of physical limitations reported by patients.…”

Section: Discussionmentioning

confidence: 99%

“…The degree of the deformity varies among patients, but the majority of patients complain of the poor cosmetic appearance caused by the deformed sternum (1,2). PE may also impair restrict chest wall movement and impair cardiorespiratory function (3)(4)(5). Patients report symptoms related to the deformity as exercise intolerance, shortness of breath, and weakness (2,6,7).…”

Section: Introductionmentioning

confidence: 99%

A prospective study on quality of life in youths after pectus excavatum correction

Lomholt

Jacobsen²,

Thastum

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The impact of correction of pectus excavatum (PE) on adolescents' health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group.Methods: Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE. A control group (n=183) consisting of school children comparable in age completed the same measure on one occasion. Results:The patients' level of HRQL before surgery was comparable to the level of the controls except for physical functioning; here boys reported impaired function compared to controls (P<0.0001, d=0.72).Both patients and parents reported improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre-to post-surgery. These improvements were statistically significant (P≤0.001-0.03) and yielded moderate to high effect sizes (ƞ 2 =0.04-0.22). Conclusions:The improvement of physical and psychosocial HRQL reported by both patients and their parents as proxy indicates the psychological implications of the deformity. Patients reported impaired physical function compared to controls. Further, pre-surgery differences in HRQL between the patients and the controls were lacking. However, the improvement in the patients' HRQL following surgery may justify the correction of pectus excavatum. The effect of the deformity on patients wellbeing compared with controls' needs to be addressed in further studies.

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“…A robust medical and anaesthetic history should be taken in the pre-operative assessment clinic. Baseline cardiorespiratory functional capacity, and aerobic fitness is known to be diminished in patients with PE (18), and it has to be assessed before surgery. Allergies and intolerance are particularly important.…”

Section: Preoperative Anaesthetic Assessmentmentioning

confidence: 99%

Anaesthetic considerations for pectus repair surgery

Patvardhan

Martínez

2016

J. Vis. Surg.

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Repair of pectus is one of the most common congenital abnormality for which patient presents for thoracic surgery. In recent years, innovative minimally invasive techniques involving video assisted thoracoscopy for pectus repair have become the norm. Similarly, anaesthetic techniques have evolved to include principles of enhanced recovery, multimodal analgesia and innovative ultrasound guided neuraxial and nerve blocks. Adequate anaesthetic set up and monitoring including the use of real time intraoperative monitoring with transesophageal echocardiography (TOE) has enabled the anaesthetist to enhance patient safety by providing instantaneous imaging of cardiac compression and complications during surgery. In this review article we aim to provide non-systematic review and institutional experience of our anaesthetic strategy to provide effective peri-operative care in this patient group.

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Effect of Pectus Excavatum Deformity on Cardiorespiratory Fitness in Adolescent Boys

Cited by 56 publications

References 23 publications

Long term cardiopulmonary effects of closed repair of pectus excavatum

Long term cardiopulmonary effects of closed repair of pectus excavatum

A prospective study on quality of life in youths after pectus excavatum correction

Anaesthetic considerations for pectus repair surgery

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