Chest

Chest

Volume 105, Issue 6, June 1994, Pages 1646-1652
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Thoracic Urgery: Clinical Investigations
Pulmonary Function Before Surgery for Pectus Excavatum and at Long-term Follow-up

https://doi.org/10.1378/chest.105.6.1646Get rights and content

Pulmonary function tests were performed before surgery on 152 patients who were operated on for pectus excavatum between 1970 and 1987 and at long-term follow-up to assess the degree of impairment and to investigate any changes caused by surgical correction. The mean age at surgery was 15.3±5.5 years. Pulmonary function was found to be restricted preoperatively. Multivariate analysis showed that preoperative pulmonary function was not related to age, the severity of the deformity at physical examination, or to pulmonary complaints. Only the patients with obstructive disease showed significantly more pulmonary complaints (p=0.042). The total lung capacity (TLC) and inspiratory vital capacity (IVC) were significantly related to the age-corrected (δ) anteroposterior diameter of the chest (lower vertebral index [LVI]) (p=0.0001). At follow-up (mean, 8.1±3.6 years), the restriction of pulmonary function was increased despite improvement in the symptoms of most patients and despite a significant increase in the anteroposterior diameter of the chest (p=0.0001): the TLC was decreased from 83.7 percent predicted (pred) preoperatively to 73.8 percent pred (p=0.0001) and the IVC from 78.3 percent pred to 70.7 percent pred (p=0.0001). The surgical results were satisfactory in 83.6 percent. No relation was found between the changes in pulmonary function measured at follow-up and the surgical results. Only the age at surgery and the changes in the TLC and IVC at follow-up were significantly related (p=0.0036, 0.0043, respectively), although the correlation coefficients were low (r=27 percent and 28 percent, respectively). The reduction in lung function at follow-up was most pronounced in the patients who had the least functional impairment (TLC >75 percent pred) preoperatively. No correlation was found between the changes in the pulmonary function test results at follow-up and follow-up interval, preoperative δLVI, and the change in δLVI at follow-up.

Section snippets

METHODS

Between 1970 and 1987, 192 patients underwent surgical repair for pectus excavatum. Only the patients who could be questioned and examined personally at the outpatients department were included in the study (N=152; 79 percent). Of these patients, 77 percent were male and 23 percent were female. The mean age at surgery was 15.3±5.5 years (range, 4.8 to 32.7 years). They were divided into age groups so that each group contained about the same number of patients to facilitate statistical analysis

RESULTS

Cardiorespiratory symptoms were observed in a considerable percentage of the patients preoperatively,10 including decreased exercise tolerance (51.3 percent), easy fatiguability (43 percent), inability to take deep breaths (37.5 percent), and shortness of breath, mainly on exertion (31.6 percent). Surgery was indicated for psychologic/cosmetic reasons in 55.2 percent and for physical symptoms in 30.5 percent. In 5.3 percent of the patients, the prospect of physical symptoms in the future was

DISCUSSION

It has frequently been stated that pectus excavatum is purely a cosmetic problem and a number of publications have discussed related symptoms.1., 2., 3., 4. Common symptoms include diminution of exercise tolerance, dyspnea on exertion, atypical chest pain, and frequent respiratory tract infection. One or more of these symptoms were present in a considerable number of our patients before surgery and significant improvement was noted in the majority at follow-up.5., 17.

Most of the studies on

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    Copyright © 1994 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.