Evaluation of the cardiac status of patients with pectus excavatum in the pre- and postoperative period.

BACKGROUND/PURPOSE: Pectus excavatum (PE) is the most common chest wall deformity in youth. Although often considered cosmetic, studies report cardiopulmonary consequences (e.g., right-ventricular compression, conduction abnormalities) that may vary with age. The minimally invasive Nuss procedure is now predominant. Objective assessment of PE's functional burden and the benefits of surgery is clinically important. To compare pre- and postoperative cardiac status in PE patients and quantify physiologic burden and surgical benefit.

METHODS

Single-center cohort of 175 patients undergoing chest wall reconstruction (retrospective 2010-2020; prospective from 2020). Preoperative work-up included pediatric surgery, pulmonology, cardiology, and CT-based Haller index. Patients with abnormal preoperative cardiology underwent postoperative reassessment (n = 61). Associations were tested with Chi-square and McNemar's tests (significance set at p < 0.05).

RESULTS

Patients were 86.3% male; mean age 16.1 years. By Haller index: severe 61.1%, moderate 16.6%, mild 22.3%; 59.4% were asymmetric. Psychological distress was reported by 63.6%. Preoperatively, 70% showed cardiac abnormalities-valvular lesions 46.3% (81/175, predominantly mitral prolapse), right-ventricular compression 33.1% (58/175), and incomplete right bundle-branch block 17.7% (31/175). Postoperatively (n = 61), right-ventricular compression resolved in all; some ECG anomalies persisted; valvular abnormalities remained in five. PE severity correlated with the presence of any cardiac abnormality, but not with psychological distress; severity did not correlate with individual abnormality types.

CONCLUSIONS

Cardiac abnormalities are common in young patients with PE and are more frequent in severe deformity. Surgical correction yields marked early improvement in structural cardiac abnormalities, supporting routine cardiac evaluation and follow-up in all patients considered for PE repair.

LEVEL OF EVIDENCE: III.