Cardiopulmonary function after chest wall deformity surgery

Pectus excavatum (PE) and carinatum (PC) are the most common types of congenital anterior chest wall deformities. The deformities often present not only as an aesthetic disturbance but also in association with mild limitation of activity, obstructive pulmonary mechanics, slight dyspnea, asthma, palpitations and abnormal cardiac physiology. Various methods of corrective thoracoplasty have been described for repair of chest deformities with different techniques. There is a significant challenge in thoracoplasty surgery which emphasizes aesthetic restoration of large deformities but should cause only low morbidity. As a result, there has been an increase in the number of patients seeking surgical correction. Some clinicians advocate surgical correction in order to improve exercise performance, whereas others believe that correction has more aesthetic than physiological benefits. However the results from alterations in cardiopulmonary physiology after surgical intervention to the thoracic wall are still a matter of controversial debate. Because of this controversial results, the fact that only few centers have a huge expertise with the correction of PE and PC and that in the literature cardiopulmonary function tests were not performed on all operated patients postoperatively, our question is if postoperative surgical PE or PC correction improve cardiopulmonary function. The aim of our prospective study is to evaluate the effect of the PE and PC deformity itself and whether there is a change of pulmonary function in patients after surgical repair. In our study all patients will undergo preoperative and postoperative evaluation with Computed Tomography CT scan, pulmonary function test and cycle ergometry in an upright and furthermore in a supine position, as well as transthoracic echocardiogram. Additional all patients will undergo a pre- and postoperative standardized questionnaire (including quality of life, patients satisfaction and physical activity) and are examinated by a professional psychologist. We hypothesize that our results provide evidence that pulmonary function is related to the depth of the depression or protrusion and probably causal for functional deficits, and might explain why repair of the defect can result in improved pulmonary function and exercise tolerance. We await clear statements for achieving an improvement in indication-setting for surgical correction of PE and PC, which to date remains a clinical decision in which alterated pulmonary function is one of several factors that need to be assessed.

Pectus excavatum (PE) and carinatum (PC) are the most common types of congenital anterior chest wall deformities. The deformities often present not only as an aesthetic disturbance but also in association with mild limitation of activity, obstructive pulmonary mechanics, slight dyspnea, palpitations and abnormal cardiac physiology. Various methods of corrective thoracoplasty have been described for repair of chest deformities with different techniques. Some clinicians advocate surgical correction in order to improve exercise performance, whereas others believe that correction has more aesthetic than physiological benefits. Clinical starting point for the project was the fact that the results from alterations in cardiopulmonary physiology after surgical intervention to the thoracic wall were still a matter of controversial debate. Because of these controversial results and the fact that in the literature cardiopulmonary function tests were not performed on all operated patients postoperatively, our question was if postoperatively surgical PE or PC corrections improve cardiopulmonary function. Thus, the aim of our prospective study was to evaluate the effect of the PE and PC deformity itself and to determine whether there is a change of pulmonary function in patients after surgical repair. Therefore, we hypothesized that following the operation there will be 1.) an improvement and 2.) no decrease in cardiopulmonary function and that 3.) body image, quality of life, psychological and physical well-being and perceived exercise ability will be seen to have improved at the various follow-up exams. In the completed project we were able to elucidate in detail that the surgical intervention did not a) influence pulmonary and echocardiographic parameters at rest and b) did not change submaximal and maximal exercise performance in the sitting and supine position in PE and/or in PC patients. The now completed project represents the first prospective study comparing pre- and postoperative outcomes in this objective and reproducible way. Our findings emphasize the high importance of standardized preoperative evaluation. Summarizing the results we were able to show that for PE as well as for the PC patients, no significant and thus patient- relevant changes in parameters of cardiopulmonary function occurred after the surgical treatment. Our study however confirmed positive effects of surgical correction of PC on self- esteem and health-related quality of life. These data will provide clear statements for improving indication-setting for surgical correction of PE and PC, which to date remained a clinical decision in which assumed altered pulmonary function was one of several factors that needed to be considered. In addition, clear conclusions such as the here demonstrated improvement of the psychological and physical well-being through surgery will also have a beneficial impact on the clinical practice. More patients will be evaluated and treated for chest wall deformities.