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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2000 February;41(1):125-30

lingua: Inglese

Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines

Haller J. A. jr. *, Loughlin G. M. **

From The ­Johns Hop­kins Chil­dren’s ­Center Bal­ti­more, USA


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.

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