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The chest wall gender divide: females have better cardiopulmonary function and exercise tolerance despite worse deformity in pectus excavatum

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Abstract

Purpose

Pectus excavatum (PE) is a chest wall deformity of variable severity and symptomatology. Existing female-specific literature highlights breast asymmetry and cosmetic reconstruction. We sought to evaluate gender differences in cardiopulmonary function.

Methods

Cardiac MRIs, pulmonary function tests (PFTs), and cardiopulmonary exercise tests (CPETs) were reviewed in 345 patients undergoing preoperative evaluation for PE. Regression modeling was used to evaluate associations between gender and clinical endpoints of cardiopulmonary function.

Results

Mean age was 15.2 years, 19% were female, 98% were white. Pectus indices included median Haller Index (HI) of 4.8, mean depression index (DI) of 0.63, correction index (CI) of 33.6%, and Cardiac Compression Index (CCI) of 2.79. Cardiac assessment revealed decreased right and left ventricular ejection fraction (RVEF, LVEF) in 16% and 22% of patients, respectively. PFTs and CPETs were abnormal in ~ 30% of patients. While females had deeper PE deformities—represented by higher pectus indices—they had superior function with higher RVEF, LVEF Z-scores, FEV1, VO2 max, O2 pulse, work, and breathing reserve (p < 0.05).

Conclusion

Despite worse PE deformity and symptomatology, females had a better cardiopulmonary function and exercise tolerance than males. Further research is needed to assess the precise mechanisms of this phenomenon and postoperative outcomes in this population.

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Acknowledgements

We would like to acknowledge our colleagues from the Divisions of Radiology and Medical Imaging, Pulmonary Medicine, and Cardiology. Our research—and the day-to-day care of patients in our comprehensive Chest Wall Center—would not be possible without this multidisciplinary collaboration.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. It was completed with internal funding from the Department of Pediatric General and Thoracic Surgery at Cincinnati Children’s Hospital Medical Center.

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Authors and Affiliations

  1. Department of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA

    Alejandra M. Casar Berazaluce, Todd M. Jenkins, Aaron P. Garrison, Victor F. Garcia & Rebeccah L. Brown

  2. Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    William D. Hardie & Karla E. Foster

  3. Division of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Tarek Alsaied, Justin Tretter & Ryan A. Moore

  4. Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Robert J. Fleck

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  1. Alejandra M. Casar Berazaluce
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Correspondence to Rebeccah L. Brown.

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Conflicts of interest

The authors have no relevant conflicts of interest or disclosures.

Ethical approval

Retrospective data collection was conducted with approval from the Cincinnati Children’s Hospital Medical Center (CCHMC) Institutional Review Board (IRB) under protocol number 2017-5823—“Retrospective review of pre-operative pulmonary and cardiac function in patients with pectus excavatum”.

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This article does not contain any experimental studies with human participants performed by any of the authors.

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Casar Berazaluce, A.M., Jenkins, T.M., Garrison, A.P. et al. The chest wall gender divide: females have better cardiopulmonary function and exercise tolerance despite worse deformity in pectus excavatum. Pediatr Surg Int 36, 1281–1286 (2020). https://doi.org/10.1007/s00383-020-04738-5

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