Cardio-Respiratory Studies in Pre and Post Operative Funnel Chest (Pectus Excavatum)

Abstract

Cardio-respiratory studies on infants are impractical. Simple operative interference is advisable before the sternum becomes fixed in the retracted position, approximately at a biological age of 18 to 24 months. Such a procedure has thus far uniformly obviated the occurrence of adverse cardio-respiratory physiology in later years. The extent of abnormal cardio-respiratory physiology in pectus excavatum is dependent upon four factors: (a) position assumed by the heart, (b) total decrease in the A.P. diameter of the chest, (c) degree and shape of depression of the sternal segments, and (d) age. Respiratory symptoms predominate throughout all age groups. Psychologic complaints are primarily noted in the second decade of life. Cardiac symptoms manifest themselves late in the course of the disease. They are apparently less influenced by surgery than either respiratory or psychologic deviations which are prone to be benefited by operation. Determination of maximum breathing capacity is the best single test of the status of respiratory physiology in funnel chest. Decreased capacity may be noted before the patient himself is symptomatically affected. Repeated determinations may indicate progress of the disease preoperatively and comparative postoperative studies show what operation has accomplished. Electrocardiographic studies are often reported abnormal but no findings peculiar to pectus excavatum are noted. In our series there were three instances entirely attributable to pectus excavatum in which improved postoperative tracings were obtained. Determination of maximum breathing capacity and electrocardiographic tracings are valuable adjuncts in evaluating the status of an individual with pectus excavatum. Cardiac catheterization studies are planned. They should give a better understanding of the disturbed physiology in pectus excavatum.