CARDIOVASCULAR AND VENTILATORY RESPONSES TO EXERCISE IN PECTUS EXCAVATUM

Abstract

HISTORY: A 29 year-old, male, had a severe pectus excavatum since infancy, which became worse during adolescent growth years. The depression persisted into adulthood with increasing symptoms. He experienced frequent episodes of pain in the lower anterior chest with mild exercise and had breathlessness and reduced endurance with mild exercise. PHYSICAL EXAMINATION: The patient had a severe pectus excavtum involving the lower 75% of the anterior chest. With deep inspiration, the depression became more severe. No cardiac murmurs were audible. The heart sounds were displaced towards the left chest. The lungs were clear on auscultation. Chest x-rays showed the heart to be shifted markedly into the left chest. The width of the chest is 21.9cm. The distance between the stemum and the spine was 5.90cm. The pectus severity index was thus, 3.71 (normal chest is 2.50). Note: The severity index is defined as the ratio between the internal transverse distance of the thorax and the vertebral-sternal distance at the most depressed portion of the deformity. DIFFERENTIAL DIAGNOSIS: Pectus Excavatum Chronic Pulmonary Disease TEST AND RESULTS: Pulmonary function tests and a maximum incremental symptom-limited exercise test on a cycle ergometer were performed two days prior to corrective surgery and six months afterwards. Results are shown below. FINAL/WORKING DIAGNOSIS: Pectus excavatum with pre-operative ventilatory limitation and premature lactate accumulation. After corrective surgery, aerobic capacity was incresed with normal cardiovascular limitation and no ventilatory limitation. TREATMENT AND OUTCOMES: Patient underwent a highly modified Ravitch repair of the pectus deformity, using a temporary internal support bar for six months. Patient progressed very well in the months following removal of the support bar; the chest is stable in the desired position. There has been considerable improvement in exercise tolerance compared to his preoperative status (see Table).Table: No Caption Available.