Abstract
PurposeTo assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR).MethodThirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years). The CMR protocol included cardiac cine images, pulmonary artery flow quantification, time resolved 3D contrast enhanced MR angiography (CEMRA) and high spatial resolution CEMRA. Chest wall indices including maximum transverse diameter, pectus index (PI), and chest-flatness were measured in all subjects. Left and right ventricular ejection fractions (LVEF, RVEF), ventricular long and short dimensions (LD, SD), mid-ventricle myocardial shortening, pulmonary-systemic circulation time, and pulmonary artery flow were quantified.ResultsIn patients with pectus excavatum, the pectus index was 9.3 ± 5.0 versus 2.8 ± 0.4 in controls (P < 0.001). No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices. In pectus excavatum, resting RV ejection fraction was reduced (53.9 ± 9.6 versus 60.5 ± 9.5; P = 0.013), RVSD was reduced (P < 0.05) both at end diastole and systole, RVLD was increased at end diastole (P < 0.05) reflecting geometric distortion of the RV due to sternal compression.ConclusionDepression of the sternum in pectus excavatum patients distorts RV geometry. Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance. Resting LV function, pulmonary circulation times and pulmonary vascular anatomy and perfusion indices were no different to controls.
Highlights
Patients with pectus excavatum, a relatively common congenital deformity, often present with symptoms such as exertional dyspnea, fatigue, chest discomfort or palpitations
No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices
Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance
Summary
A relatively common congenital deformity, often present with symptoms such as exertional dyspnea, fatigue, chest discomfort or palpitations. The suggested etiology for this abnormality, uncertain, has been described as an overgrowth of the costal cartilages in utero, usually ribs 4, 5, 6, 7, and 8, which limits the elevation of the sternum [1]. Posterior invagination of the sternum shifts the values. There is no consensus among investigators on the existence or degree of cardiopulmonary impairment in pectus excavatum patients. The clinical significance of the physiological findings in pectus excavatum patients has remained controversial [8,9] leading some to consider corrective surgery a cosmetic procedure
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