Exercise impairment in patients with pectus excavatum? A scoping review of evidence and role of arterial content change during effort.

This scoping review describes cardiopulmonary fitness in non-operated patients with pectus excavatum and maps the reporting of hemoglobin and arterial oxygen content during exercise. Four databases (PubMed, ScienceDirect, CINAHL, and SPORTDiscus) were searched from inception to February 15th, 2025. Cross-sectional studies, cohort studies, and randomized controlled trials reporting exercise capacity or exercise testing outcomes were included. Among 612 identified records, 31 studies involving 2937 patients met all eligibility criteria. Seventeen studies reported maximal oxygen uptake (VO2max) as a percentage of predicted values, ranging from 62% ± 25% to 101.0% ± 18.3%, indicating substantial heterogeneity in exercise capacity. Hemoglobin concentration was quantified in only one study (11.6 to 17.3 g/100 mL). Pulse oximetry was assessed in 15 studies but quantitatively reported in four (95.5% ± 2.1% to 97.4% ± 1.2%). Blood gases were assessed in five studies, with results reported in two, including alveolar-arterial oxygen pressure difference at maximal exercise and arterial oxygen pressure decline during effort. Overall, exercise capacity seems to be impaired in patients with PEx, and hemoglobin and oxygen-related parameters remain underreported.