Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum

Eur J Cardiothorac Surg. 2012 May;41(5):1063-7. doi: 10.1093/ejcts/ezr170. Epub 2011 Dec 21.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cardiac Output / physiology
  • Case-Control Studies
  • Exercise Test / methods
  • Forced Expiratory Volume / physiology
  • Funnel Chest / diagnostic imaging
  • Funnel Chest / physiopathology*
  • Funnel Chest / surgery*
  • Heart Rate / physiology
  • Humans
  • Minimally Invasive Surgical Procedures / methods
  • Oxygen Consumption / physiology
  • Postoperative Period
  • Spirometry / methods
  • Treatment Outcome
  • Ultrasonography
  • Vital Capacity / physiology