Normalized Cardiopulmonary Exercise Function in Patients With Pectus Excavatum Three Years After Operation

• Published in: The Annals of thoracic surgery Vol. 96; no. 1; pp. 272 - 278
• Main Authors: Maagaard, Marie, MS, Tang, Mariann, MD, PhD, Ringgaard, Steffen, MSc, PhD, Nielsen, Hans Henrik M., MD, PhD, Frøkiær, Jørgen, MD, PhD, Haubuf, Maj, MD, Pilegaard, Hans K., MD, Hjortdal, Vibeke E., MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.07.2013
• Subjects: Adolescent; Cardiothoracic Surgery; Exercise - physiology; Exercise Test - methods; Female; Follow-Up Studies; Funnel Chest - diagnosis; Funnel Chest - physiopathology; Funnel Chest - surgery; Humans; Lung - physiology; Magnetic Resonance Imaging; Male; Postoperative Period; Prospective Studies; Recovery of Function; Respiratory Function Tests - methods; Surgery; Surveys and Questionnaires; Thoracoplasty; Time Factors; Treatment Outcome; 5
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2013.03.034

Background During exercise cardiac function is often limited in patients with pectus excavatum. Therefore, we hypothesized that cardiopulmonary exercise function would improve after the Nuss procedure. Methods Seventy-five teenagers (49 patients, 26 controls) were investigated at rest and during bicycle exercise before surgery, and 1 year and 3 years postoperatively (after pectus-bar removal). Echocardiography and lung spirometry were performed at rest. Cardiac output, heart rate, and aerobic exercise capacity were measured using a photoacoustic gas-rebreathing technique during rest and exercise. Results Forty-four patients and 26 controls completed 3 years follow-up. Preoperatively, patients had lower maximum cardiac index, mean ±SD, 6.6 ± 1.2 l·min-1 ·m−2 compared with controls 8.1 ± 1.0 l·min-1 ·m−2 during exercise ( p  = 0.0001). One year and 3 years postoperatively, patients' maximum cardiac index had increased significantly and after 3 years there was no difference between patients and controls (8.1 ± 1.2 l·min-1 ·m−2 and 8.3 ± 1.6 l·min-1 ·m−2 , respectively [ p  = 0.572]). The maximum oxygen consumption was unchanged. Left ventricular dimensions increased in patients over 3 years; however, no difference was seen between the 2 groups. Preoperatively, patients had lower forced expiratory volume in the first second of expiration (FEV1 ; 86% ± 13%) as compared with controls (94% ± 10%), p  = 0.009. Postoperatively, no difference was found in FEV1 between the 2 groups. Conclusions Before operation, FEV1 and maximum cardiac index were lower in patients compared with healthy, age-matched controls. One year after, both parameters had increased, although only FEV1 had normalized. After 3 years and bar removal, cardiopulmonary function in patients during exercise had normalized.