Increasing Severity of Pectus Excavatum Is Associated with Reduced Pulmonary Function

Authors

M. Louise Lawson, Kennesaw State UniversityFollow
Robert B. Mellins, Columbia University Medical CenterFollow
James F. Paulson, Eastern Virginia Medical School
Robert C. Shamberger, Harvard Medical School
Keith Oldham, Medical College of Wisconsin
Richard G. Azizkhan, University of CincinnatiFollow
Andre V. Hebra, Medical University of South CarolinaFollow
Donald Nuss, Eastern Virginia Medical School
Michael J. Goretsky, Eastern Virginia Medical School
Ronald J. Sharp, Children’s Mercy Hospital, Kansas City, MOFollow
George W. Holcomb III, Children’s Mercy Hospital, Kansas City, MOFollow
Walton K. T. Shim, Kapi’olani Medical Center for Women and Children, Honolulu, HIFollow
Stephen M. Megison, University of Texas Southwestern Medical School
R. Lawrence Moss, Yale New Haven Children’s HospitalFollow
Annie H. Fecteau, University of Toronto Faculty of MedicineFollow
Paul M. Colombani, Johns Hopkins University Medical CenterFollow
Alan B. Moskowitz, Children’s Hospital of The King’s Daughters, Norfolk, VAFollow
Joshua Hill, University of Toronto Faculty of MedicineFollow
Robert E. Kelly Jr., Eastern Virginia Medical School

Document Type

Article

Publication Date

3-21-2011

Abstract

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 <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV₁ <80% predicted; FEV₁/FVC >80%). Patients with a Haller index of 7 are >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.