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

Abstract

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. 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. 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. 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.