Quantitative assessment of right ventricular function in pectus excavatum

Abstract

Pectus excavatum is a common congenital chest wall deformity. Underlying cardiac chambers, in particular the right atrium and right ventricle (RV), may be compressed between the vertebral column and the depressed sternum in patients with this thoracic deformity. Citing improvement in indices of cardiovascular function after corrective surgery, some investigators have suggested that the deformed chest may contribute to cardiopulmonary impairment. Although cardiopulmonary impairment certainly may contribute to symptoms in patients with pectus excavatum and guide the need for and timing of corrective surgery, guidelines for the assessment of resting cardiovascular function remain undefined. Furthermore, the qualitative echocardiographic assessment of RV function and volumes among patients with pectus excavatum may be technically difficult and limited by subjectivity. Quantitative echocardiographic parameters, such as tricuspid annular plane systolic excursion (TAPSE) and RV fractional area change, may offer a more accurate assessment of RV function in this anatomically distinct population. Cardiac magnetic resonance (CMR) imaging has emerged as the criterion standard in RV functional assessment and, more recently, has been validated in patients with pectus excavatum. We compared qualitative assessment of RV systolic impairment by visual echocardiographic inspection with quantitative assessment of RV function with CMR and echocardiographically derived TAPSE and RV fractional area change in a series of patients referred to our institution with mild to severe symptomatic pectus excavatum. Patients were being considered for corrective surgery. Our hypothesis was that the patients would be found to have normal RV function when assessed quantitatively, either through CMR or quantitative echocardiographic examination, despite impairment seen qualitatively.