Document Detail

Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines.
MedLine Citation:
PMID:  10836238     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pectus excavatum is a congenital chest abnormality which may become more marked during childhood and teenage growth. Young teenagers with severe PE deformities often become short of breath during strenuous exercise and complain of becoming easily fatigued. The pathophysiologic effects of PE remain controversial because they have been difficult to measure, especially in young children. Symptomatic patients often have significant subjective improvement during exercise following PE repair and there is a major cosmetic impact on teenagers with severe deformities. This study was designed to measure pulmonary and cardiac function with exercise before and after corrective surgery. METHODS: Pulmonary function testing and incremental exercise testing were performed in 36 adolescents with pectus excavatum (PE) and 10 age-matched, healthy control subjects. Six months after corrective surgery was performed, 15 of these PE patients and 6 control subjects were re-evaluated for pulmonary function. RESULTS: Before surgery, PE subjects had a lower forced vital capacity (FVC) than controls; there was no change in FVC after surgery. Before surgery, 58% of PE patients had subjective complaints of exercise limitation; 66% of the patients were significantly improved after surgery. PE subjects exercised at a similar workload to controls. Respiratory parameters during exercise were similar between the two groups before surgery, indicating that exercise was not limited by restrictive lung disease. After surgery, PE subjects exercised longer and had a higher oxygen pulse than before surgery, whereas controls showed no such changes. Although some PE subjects showed mild restrictive lung function, surgical repair did not influence this mild degree of restriction. CONCLUSIONS: After corrective surgery, PE patients have increased exercise tolerance and a higher oxygen pulse. Oxygen pulse is a measure of cardiac output. Results suggest that PE repair improves cardiopulmonary function during vigorous exercise. Based upon these studies, and our experience in the treatment of more than 700 surgical patients with pectus excavatum over a 40-year period, guidelines for the diagnosis and management of children with pectus excavatum are proposed.
J A Haller; G M Loughlin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of cardiovascular surgery     Volume:  41     ISSN:  0021-9509     ISO Abbreviation:  J Cardiovasc Surg (Torino)     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-06-08     Completed Date:  2000-06-08     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0066127     Medline TA:  J Cardiovasc Surg (Torino)     Country:  ITALY    
Other Details:
Languages:  eng     Pagination:  125-30     Citation Subset:  IM    
The Johns Hopkins Children's Center, Baltimore, MD 21287-3716, USA.
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MeSH Terms
Cardiac Output / physiology
Exercise Test
Forced Expiratory Volume / physiology
Funnel Chest / complications,  physiopathology,  surgery*
Oxygen / blood
Practice Guidelines as Topic
Respiratory Insufficiency / etiology,  physiopathology,  surgery*
Vital Capacity / physiology
Reg. No./Substance:

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