The Severity of Pectus Excavatum Defect Is Associated With Impaired Cardiopulmonary Function

BACKGROUND Repair of pectus excavatum has cosmetic benefits, but the physiologic impact remains controversial. The aim of this study was to characterize the relationship between the degree of pectus excavatum and cardiopul-monary dysfunction seen on cardiac magnetic resonance (CMR) imaging, cardiopulmonary exercise testing (CPET), and pulmonary function testing (PFT). METHODS A single-center analysis of CMR, CPET, and PFT was conducted. Regression models evaluated relation-ships between pectus indices and the clinical end points of cardiopulmonary function.RESULTS Data from 345 CMRs, 261 CPETs, and 281 PFTs were analyzed. Patients were a mean age of 15.2 +/- 4 years, and 81% were aged <18 years. The right ventricular ejection fraction (RVEF) was <0.50 in 16% of patients, left ventricular ejection fraction (LVEF) was <0.55 in 22%, RVEF Z-score was <-2 in 32%, and the LVEF Z-score was <-2 in 18%. CPET revealed 33% of patients had reduced aerobic fitness. PFT results were abnormal in 23.1% of patients. Adjusted analyses revealed the Haller index had significant (P < .05) inverse associations with RVEF and LVEF. CONCLUSIONS The severity of pectus excavatum is associated with ventricular systolic dysfunction. Pectus exca-vatum impacts right and left ventricular systolic function and can also impact exercise tolerance. The Haller index and correction index may be the most useful predictors of impairment.(Ann Thorac Surg 2022;114:1015-21)(c) 2022 by The Society of Thoracic Surgeons