Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum.

OBJECTIVES

Patients with pectus excavatum have compromised cardiac function during exercise. We hypothesized that the Nuss technique would improve cardiopulmonary function during exercise.

METHODS

We investigated 75 teenagers (49 patients and 26 controls) at rest and during bicycle exercise prior to surgery and 1 year postoperative.

RESULTS

Prior to surgery, patients had a lower cardiac index 6.6 ± 1.1 l/min/m(2) when compared with controls 8.1 ± 1.0 l/min/m(2) during submaximal exercise, P = 0.0001. There was no difference in heart rate or increase in heart rate between the two groups. One year after surgery, cardiac index had significantly increased in the pectus group, P = 0.0054 although cardiac index was still significantly lower 7.2 ± 1.0 l/min/m(2) when compared with the control subjects (8.5 ± 1.6 l/min/m(2), P = 0.0008). Both the patients and the controls increased their VO(2) max during the one-year study period although the controls increased most. Right ventricular diastolic dimension increased in both groups over the one-year study period and left ventricular dimensions increased in the patients. Before operation, the patients had lower forced expiratory capacity FEV(1) 86 ± 13% when compared with controls 94 ± 10%, P = 0.009. Patients increased FEV(1)/forced vital capacity over the one-year long study course although there were no differences between groups.

CONCLUSION

Patients with pectus excavatum have lower cardiac index at submaximal exercise when compared with healthy age-matched controls. Their cardiac index and FEV(1) are increased one year after the modified Nuss operation.