Increasing Severity of Pectus Excavatum is Associated with Reduced Pulmonary Function

• Published in: The Journal of pediatrics 2011-08, Vol.159 (2), p.256-261.e2
• Main Authors: Lawson, M. Louise, PhD, Mellins, Robert B., MD, Paulson, James F., PhD, Shamberger, Robert C., MD, Oldham, Keith, MD, Azizkhan, Richard G., MD, Hebra, Andre V., MD, Nuss, Donald, MB, ChB, Goretsky, Michael J., MD, Sharp, Ronald J., MD, Holcomb, George W., MD, Shim, Walton K.T., MD, Megison, Stephen M., MD, Moss, R. Lawrence, MD, Fecteau, Annie H., MD, Colombani, Paul M., MD, Moskowitz, Alan B., MS, Hill, Joshua, BS, Kelly, Robert E., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; breathing; Child; Disease Progression; Female; Follow-Up Studies; Forced Expiratory Flow Rates - physiology; Funnel Chest - complications; Funnel Chest - diagnosis; Funnel Chest - physiopathology; General aspects; Humans; lung function; Male; Medical sciences; patients; Pediatrics; Prognosis; Prospective Studies; Radiography, Thoracic; Respiratory Insufficiency - diagnosis; Respiratory Insufficiency - etiology; Respiratory Insufficiency - physiopathology; Severity of Illness Index; Spirometry; Tomography, X-Ray Computed; Vital Capacity - physiology; Young Adult
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.01.065

Objective To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. Study design We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. Results The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1 ), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV1 /FVC 4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. Conclusions Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.