Impact of pectus excavatum deformity on the cardiopulmonary function: a literature review

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Abstract

BACKGROUND: Pectus excavatum deformity is the most common chest wall malformation. Currently, surgeons and researchers of this problem have no consensus on whether pectus excavatum is a purely aesthetic problem or whether pectus excavatum disturbs the function of the cardiopulmonary system.

AIM: To analyze publications on the effect of pectus excavatum on the cardiorespiratory system and the functional features of the heart and lung after thoracoplasty in patients with pectus excavatum.

MATERIALS AND METHODS: Data were searched in the scientific databases PubMed, Google Scholar, Cochrane Library, Crossref, and eLibrary without language limitation. In this article, the method of analysis and synthesis of information was used. Most of the studies included in the analysis were published in the last 20 years.

RESULTS: In patients with pectus excavatum, severity of cardiorespiratory dysfunction depends on the degree of chest deformity. According to obtained data, the pulmonary function test in patients with pectus excavatum in the majority of cases revealed restrictive pattern (formed vital capacity <80% of the norm, with normal ratio of forced expiratory volume in 1 minute to forced lung capacity). In most cases, echocardiography showed compression of the right heart chambers. Comparative analysis of the pre- and postoperative study of cardiorespiratory system in most cases indicated improvement and adaptation of the cardiopulmonary system to stress after surgical intervention.

CONCLUSIONS: Funnel chest is an aesthetic problem wherein a severe degree of deformity leads to impaired respiratory mechanics and dysfunction of the cardiovascular system. Surgical restoration of the volume of the retrosternal space allows improvement of the functional capabilities of the heart and lungs.

About the authors

Alina М. Khodorovskaya

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: alinamyh@gmail.com
ORCID iD: 0000-0002-2772-6747
SPIN-code: 3348-8038

MD

Russian Federation, Saint Petersburg

Dmitry V. Ryzhikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dryjikov@yahoo.com
ORCID iD: 0000-0002-7824-7412
SPIN-code: 7983-4270

MD, PhD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg

Bahauddin H. Dolgiev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: dr-b@bk.ru
ORCID iD: 0000-0003-2184-5304
SPIN-code: 2348-4418

MD

Russian Federation, Saint Petersburg

References

  1. Fokin AA, Steuerwald NM, Ahrens WA, et al. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;21(1):44–57. doi: 10.1053/j.semtcvs.2009.03.001
  2. Goretsky MJ, McGuire MM. Complications associated with the minimally invasive repair of pectus excavatum. Semin Pediatr Surg. 2018;27(3):151–155. doi: 10.1053/j.sempedsurg.2018.05.001
  3. Westphal FL, Lima LC, Lima Neto JC, et al. Prevalence of pectus carinatum and pectus excavatum in students in the city of Manaus, Brazil. J Bras Pneumol. 2009;35(3):221–226. doi: 10.1590/s1806-37132009000300005
  4. Billar RJ, Manoubi W, Kant SG, et al. Association between pectus excavatum and congenital genetic disorders: a systematic review and practical guide for the treating physician. J Pediatr Surg. 2021;56(12):2239–2252. doi: 10.1016/j.jpedsurg.2021.04.016
  5. Khodorovskaya AМ, Agranovich OE, Savina MV, et al. Poland–Mebius syndrome: a clinical case and review of the literature. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2024;12(1):53–64. EDN: MJXMHT doi: 10.17816/PTORS623349
  6. Creswick HA, Stacey MW, Kelly RE Jr, et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg. 2006;41(10):1699–1703. doi: 10.1016/j.jpedsurg.2006.05.071
  7. Fonkalsrud EW. Current management of pectus excavatum. World J Surg. 2003;27(5):502–508. doi: 10.1007/s00268-003-7025-5
  8. Koumbourlis AC, Stolar CJ. Lung growth and function in children and adolescents with idiopathic pectus excavatum. Pediatr Pulmonol. 2004;38(4):339–343. doi: 10.1002/ppul.20062
  9. Kelly RE Jr, Obermeyer RJ, Nuss D. Diminished pulmonary function in pectus excavatum: from denying the problem to finding the mechanism. Ann Cardiothorac Surg. 2016;5(5):466–475. doi: 10.21037/acs.2016.09.09
  10. Biavati M, Kozlitina J, Alder AC, et al. Prevalence of pectus excavatum in an adult population-based cohort estimated from radiographic indices of chest wall shape. PLoS One. 2020;15(5). doi: 10.1371/journal.pone.0232575
  11. Skrzypczak P, Kamiński M, Pawlak K, et al. Seasonal interest in pectus excavatum and pectus carinatum: a retrospective analysis of Google Trends data. J Thorac Dis. 2021;13(2):1036–1044. doi: 10.21037/jtd-20-2924
  12. Jayaramakrishnan K, Wotton R, Bradley A, et al. Does repair of pectus excavatum improve cardiopulmonary function? Interact Cardiovasc Thorac Surg. 2013;16(6):865–870. doi: 10.1093/icvts/ivt045
  13. Dolgiev BH, Ryzhikov DV, Vissarionov SV. Surgical treatment of children with asymmetric pectus excavatum: literature review. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2022;10(4):471–479. EDN: VCVCLZ doi: 10.17816/PTORS112043
  14. Malek MH, Berger DE, Marelich WD, et al. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg. 2006;30(4):637–643. doi: 10.1016/j.ejcts.2006.07.004
  15. Dupuis M, Daussy L, Noel-Savina E, et al. Impact of pectus excavatum on pulmonary function and exercise capacity in patients treated with 3D custom-made silicone implants. Ann Chir Plast Esthet. 2024;69(1):53–58. doi: 10.1016/j.anplas.2023.01.002
  16. Eideken J, Wolferth CC. The heart in funnel chest. Am J M Sci. 1932;84:445–452.
  17. Pimenta J, Vieira A, Henriques-Coelho T. Ventricular arrhythmia solved by surgical correction of pectus excavatum. Interact Cardiovasc Thorac Surg. 2018;26(4):706–708. doi: 10.1093/icvts/ivx397
  18. Landtman B. The heart in funnel chest; pre- and postoperative studies of seventy cases. Ann Paediatr Fenn. 1958;4(3):181–190.
  19. Mocchegiani R, Badano L, Lestuzzi C, et al. Relation of right ventricular morphology and function in pectus excavatum to the severity of the chest wall deformity. Am J Cardiol. 1995;76(12):941–946. doi: 10.1016/s0002-9149(99)80266-5
  20. Jaroszewski DE, Velazco CS, Pulivarthi VSKK, et al. Cardiopulmonary function in thoracic wall deformities: what do we really know? Eur J Pediatr Surg. 2018;28(4):327–346. doi: 10.1055/s-0038-1668130
  21. Chu ZG, Yu JQ, Yang ZG, et al. Correlation between sternal depression and cardiac rotation in pectus excavatum: evaluation with helical CT. AJR Am J Roentgenol. 2010;195(1):W76–W80. doi: 10.2214/AJR.09.3199
  22. Sarioglu FC, Gezer NS, Odaman H, et al. Lung density analysis using quantitative computed tomography in children with pectus excavatum. Pol J Radiol. 2021;86:372–e379. doi: 10.5114/pjr.2021.107685
  23. Malek MH, Berger DE, Housh TJ, et al. Cardiovascular function following surgical repair of pectus excavatum: a meta-analysis. Chest. 2006;130(2):506–516. doi: 10.1378/chest.130.2.506
  24. Guntheroth WG, Spiers PS. Cardiac function before and after surgery for pectus excavatum. Am J Cardiol. 2007;99(12):1762–1764. doi: 10.1016/j.amjcard.2007.01.064
  25. Liu C, Wen Y. Research progress in the effects of pectus excavatum on cardiac functions. World J Pediatr Surg. 2020;3(2). doi: 10.1136/wjps-2020-000142
  26. Chao CJ, Jaroszewski DE, Kumar PN, et al. Surgical repair of pectus excavatum relieves right heart chamber compression and improves cardiac output in adult patients – an intraoperative transesophageal echocardiographic study. Am J Surg. 2015;210(6):1118–1125. doi: 10.1016/j.amjsurg.2015.07.006
  27. Jeong JY, Park HJ, Lee J, et al. Cardiac morphologic changes after the Nuss operation for correction of pectus excavatum. Ann Thorac Surg. 2014;97(2):474–478. doi: 10.1016/j.athoracsur.2013.10.018
  28. Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac compression with the Nuss minimally invasive repair for pectus excavatum. J Pediatr Surg. 2006;41(4):683–686. doi: 10.1016/j.jpedsurg.2005.12.009
  29. Karabulut M. Increased incidence of mitral valve prolapse in children with pectus chest wall deformity. Pediatr Int. 2023;65(1). doi: 10.1111/ped.15582
  30. Laín A, Giralt G, Giné C, et al. Transesophageal echocardiography during pectus excavatum correction in children: what happens to the heart? J Pediatr Surg. 2021;56(5):988–994. doi: 10.1016/j.jpedsurg.2020.06.009
  31. Jaroszewski DE, Farina JM, Gotway MB, et al. Cardiopulmonary outcomes after the nuss procedure in pectus excavatum. J Am Heart Assoc. 2022;11(7). doi: 10.1161/JAHA.121.022149
  32. Chao CJ, Jaroszewski D, Gotway M, et al. Effects of pectus excavatum repair on right and left ventricular strain. Ann Thorac Surg. 2018;105(1):294–301. doi: 10.1016/j.athoracsur.2017.08.017
  33. Töpper A, Polleichtner S, Zagrosek A, et al. Impact of surgical correction of pectus excavatum on cardiac function: insights on the right ventricle. A cardiovascular magnetic resonance study. Interact Cardiovasc Thorac Surg. 2016;22(1):38–46. doi: 10.1093/icvts/ivv286
  34. Krueger T, Chassot PG, Christodoulou M, et al. Cardiac function assessed by transesophageal echocardiography during pectus excavatum repair. Ann Thorac Surg. 2010;89(1):240–243. doi: 10.1016/j.athoracsur.2009.06.126
  35. O’Keefe J, Byrne R, Montgomery M, et al. Longer term effects of closed repair of pectus excavatum on cardiopulmonary status. J Pediatr Surg. 2013;48(5):1049–1054. doi: 10.1016/j.jpedsurg.2013.02.024
  36. Obermeyer RJ, Cohen NS, Jaroszewski DE. The physiologic impact of pectus excavatum repair. Semin Pediatr Surg. 2018;27(3):127–132. doi: 10.1053/j.sempedsurg.2018.05.005
  37. Tang M, Nielsen HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg. 2012;41(5):1063–1067. doi: 10.1093/ejcts/ezr170
  38. Kelly RE Jr, Mellins RB, Shamberger RC, et al. Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg. 2013;217(6):1080–1089. doi: 10.1016/j.jamcollsurg.2013.06.019
  39. Ruzikulov USh. Clinical manifestations of funnel chest deformity in children of different ages. Journal of Theoretical and Clinical Medicine. 2014;(2):110–112. EDN: ZBLVFB (In Russ.)
  40. Nuss D, Obermeyer RJ, Kelly RE Jr. Pectus excavatum from a pediatric surgeon’s perspective. Ann Cardiothorac Surg. 2016;5(5):493–500. doi: 10.21037/acs.2016.06.04
  41. Jaroszewski DE. Physiologic implications of pectus excavatum. J Thorac Cardiovasc Surg. 2017;153(1):218–219. doi: 10.1016/j.jtcvs.2016.09.045
  42. Kelly RE Jr, Obermeyer RJ, Goretsky MJ, et al. Recent modifications of the Nuss procedure: the pursuit of safety during the minimally invasive repair of pectus excavatum. Ann Surg. 2022;275(2):e496–e502. doi: 10.1097/SLA.0000000000003877
  43. Sarwar ZU, DeFlorio R, O’Connor SC. Pectus excavatum: current imaging techniques and opportunities for dose reduction. Semin Ultrasound CT MR. 2014;35(4):374–381. doi: 10.1053/j.sult.2014.05.003
  44. Ramadan S, Wilde J, Tabard-Fougère A, et al. Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum. BMJ Open Respir Res. 2021;8(1). doi: 10.1136/bmjresp-2021-001020
  45. Katrancioglu O, Karadayi ŞULE, Kutanoglu N. Outcomes of the minimally invasive Nuss procedure for pectus excavatum. Medicine Science. 2024;13(1):126–130. doi: 10.5455/medscience.2023.12.229
  46. Culver BH, Graham BL, Coates AL, et al. Recommendations for a standardized pulmonary function report. an official American Thoracic Society technical statement. Am J Respir Crit Care Med. 2017;196(11):1463–1472. doi: 10.1164/rccm.201710-1981ST
  47. LoMauro A, Pochintesta S, Romei M, et al. Rib cage deformities alter respiratory muscle action and chest wall function in patients with severe osteogenesis imperfecta. PLoS One. 2012;7(4). doi: 10.1371/journal.pone.0035965
  48. Redlinger RE Jr, Kelly RE, Nuss D, et al. Regional chest wall motion dysfunction in patients with pectus excavatum demonstrated via optoelectronic plethysmography. J Pediatr Surg. 2011;46(6):1172–1176. doi: 10.1016/j.jpedsurg.2011.03.047
  49. Binazzi B, Innocenti Bruni G, Coli C, et al. Chest wall kinematics in young subjects with Pectus excavatum. Respir Physiol Neurobiol. 2012;180(2–3):211–217. doi: 10.1016/j.resp.2011.11.008
  50. Janssen N, Coorens NA, Franssen AJPM, et al. Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification. J Thorac Dis. 2024;16(2):1687–1701. doi: 10.21037/jtd-23-957
  51. Maagaard M, Tang M, Ringgaard S, et al. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg. 2013;96(1):272–278. doi: 10.1016/j.athoracsur.2013.03.034
  52. Sigalet DL, Montgomery M, Harder J. Cardiopulmonary effects of closed repair of pectus excavatum. J Pediatr Surg. 2003;38(3):380–385. doi: 10.1053/jpsu.2003.50112
  53. Jeong JY, Ahn JH, Kim SY, et al. Pulmonary function before and after the Nuss procedure in adolescents with pectus excavatum: correlation with morphological subtypes. J Cardiothorac Surg. 2015;10:37. doi: 10.1186/s13019-015-0236-7
  54. Borowitz D, Cerny F, Zallen G, et al. Pulmonary function and exercise response in patients with pectus excavatum after Nuss repair. J Pediatr Surg. 2003;38(4):544–547. doi: 10.1053/jpsu.2003.50118
  55. Jukić M, Mustapić I, Šušnjar T, et al. Minimally invasive modified Nuss procedure for repair of pectus excavatum in pediatric patients: single-centre retrospective observational study. Children (Basel). 2021;8(11):1071. doi: 10.3390/children8111071
  56. Noguchi M, Hoshino Y, Yaguchi K, et al. Does aggressive respiratory rehabilitation after primary nuss procedure improve pulmonary function? J Pediatr Surg. 2020;55(4):615–618. doi: 10.1016/j.jpedsurg.2019.05.023
  57. Szydlik S, Jankowska-Szydlik J, Zwaruń D, et al. An effect of Nuss procedure on lung function among patients with pectus excavatum. Pol Przegl Chir. 2013;85(1):1–5. doi: 10.2478/pjs-2013-0001
  58. Zens TJ, Casar Berazaluce AM, Jenkins TM, et al. The severity of pectus excavatum defect is associated with impaired cardiopulmonary function. Ann Thorac Surg. 2022;114(3):1015–1021. doi: 10.1016/j.athoracsur.2021.07.051
  59. Del Frari B, Blank C, Sigl S, et al. The questionable benefit of pectus excavatum repair on cardiopulmonary function: a prospective study. Eur J Cardiothorac Surg. 2021;61(1):75–82. doi: 10.1093/ejcts/ezab296
  60. Dreher C, Reinsberg M, Oetzmann von Sochaczewski C, et al. Changes in pulmonary functions of adolescents with pectus excavatum throughout the Nuss procedure. J Pediatr Surg. 2023;58(9):1674–1678. doi: 10.1016/j.jpedsurg.2023.02.057
  61. Wang Q, Fan S, Wu C, et al. Changes in resting pulmonary function testing over time after the Nuss procedure: a systematic review and meta-analysis. J Pediatr Surg. 2018;53(11):2299–2306. doi: 10.1016/j.jpedsurg.2018.02.052
  62. Walsh J, Walsh R, Redmond K. Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK. BMJ Open Respir Res. 2023;10(1). doi: 10.1136/bmjresp-2023-001665
  63. Wynn SR, Driscoll DJ, Ostrom NK, et al. Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation. J Thorac Cardiovasc Surg. 1990;99(1):41–47.
  64. Castellani C, Windhaber J, Schober PH, et al. Exercise performance testing in patients with pectus excavatum before and after Nuss procedure. Pediatr Surg Int. 2010;26(7):659–663. doi: 10.1007/s00383-010-2627-0
  65. Das BB, Recto MR, Yeh T. Improvement of cardiopulmonary function after minimally invasive surgical repair of pectus excavatum (Nuss procedure) in children. Ann Pediatr Cardiol. 2019;12(2):77–82. doi: 10.4103/apc.APC_121_18
  66. Humphries CM, Anderson JL, Flores JH, et al. Cardiac magnetic resonance imaging for perioperative evaluation of sternal eversion for pectus excavatum. Eur J Cardiothorac Surg. 2013;43(6):1110–1113. doi: 10.1093/ejcts/ezs662

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