DOES PECTUS EXCAVATUM IMPAIR EXERCISE PERFORMANCE?:

PURPOSE: Pectus excavatum (PE) is a concave deformity of the chest wall. While it occurs most commonly in healthy adolescent males, it may be seen in the young child. Affected patients often complain of exercise intolerance. The effect of PE on cardiopulmonary function remains controversial. There is evidence to suggest that PE may cause cardiac compression with an associated reduction in stroke volume (SV). Objective assessment of functional impairment is essential as surgical correction has largely been considered for cosmetic purposes only. METHODS: We studied 12 patients with PE and 12 healthy controls matched for age, sex, race and weight using the Bruce protocol on treadmill. Peak oxygen consumption (VO2), heart rate (HR), ventilation (VE), and oxygen pulse (O2P) were recorded. Anaerobic threshold (VAT) and HR slope were calculated. RESULTS: 10 males and 2 females, aged 13 (5–17) years were studied. PE patients had a lower peak VO2 (37+/− 5 vs 46+/− 6 ml/kg/min, p = .01), VAT (22+/− 4 vs. 29+/− 5 ml/kg/min, p = .02) and O2P (10+/− 3 vs 13+/− 5, p = .003) but a higher HR slope (82+/5 vs 69+/− 5, p = .02). Peak HR did not differ (193 vs 195 bpm, p = NS). Older age related to higher VO2 (r = .8), O2P (r = .9) and lower HR slope (r = −.9) in healthy controls attesting to the fact that performance in the younger child is largely HR dependent. Within the PE group however, older age related to a lower VO2 (r = −.7). Conclusion: PE is associated with significant impairment in aerobic capacity with evidence of a reduced SV suggested by a reduced O2P and elevated HR slope. Older patients have greater impairment which may be due to progressive deformity over time or due to their greater reliance on SV than HR to augment cardiac output. Cardiopulmonary stress testing serves as a valuable tool to provide objective evidence of cardiac impairment in these patients.