Pectus Excavatum: Functional Respiratory Impact, Quality of Life, and Preoperative Assessment



Pectum excavatum’s (PE) functional impact is discussed. To this day, there is no consensus despite the many studies published on that subject. This explains that there are no official guidelines regarding the evaluation of patients with PE. However, some authors suggested guidelines on the indications of corrective surgery (Nuss, or modified Ravitch) [1–3]. But the definition of functional respiratory and cardiac impairment may not be described precisely enough. Moreover, they used a radiological measure (Haller index) although several studies showed a lack of correlation with the physiological impairment of the deformity [4–6] and no impact on the patient’s quality of life [7, 8]. The aesthetic damage and its psycho-social impact were not always considered. The plastic surgery solutions were not part of the decision algorithm.


  1. 1.
    Frantz FW. Indications and guidelines for pectus excavatum repair. Curr Opin Pediatr. 2011;23(4):486–91.CrossRefGoogle Scholar
  2. 2.
    Nuss D, Kelly RE. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin. 2010;20(4):583–97.CrossRefGoogle Scholar
  3. 3.
    Jaroszewski D, Notrica D, McMahon L, Steidley DE, Deschamps C. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23(2):230–9.CrossRefGoogle Scholar
  4. 4.
    Cavestri B, Wurtz A, Bart F, Nevière R, Aguilaniu B, Wallaert B. [Cardiopulmonary exercise testing in patients with pectus excavatum]. Rev Mal Respir. 2010;27(7):717–23.Google Scholar
  5. 5.
    Maagaard M, Tang M, Ringgaard S, Nielsen HHM, Frøkiær J, Haubuf M, et al. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg. 2013;96(1):272–8.CrossRefGoogle Scholar
  6. 6.
    Chao C-J, Jaroszewski DE, Kumar PN, Ewais MM, Appleton CP, Mookadam F, et al. Surgical repair of pectus excavatum relieves right heart chamber compression and improves cardiac output in adult patients—an intraoperative transesophageal echocardiographic study. Am J Surg. 2015;210(6):1118–24; discussion 1124–5.CrossRefGoogle Scholar
  7. 7.
    Ewert F, Syed J, Kern S, Besendörfer M, Carbon RT, Schulz-Drost S. Symptoms in pectus deformities: a scoring system for subjective physical complaints. Thorac Cardiovasc Surg. 2017;65(1):43–9.CrossRefGoogle Scholar
  8. 8.
    Kelly RE, Cash TF, Shamberger RC, Mitchell KK, Mellins RB, Lawson ML, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. Pediatrics. 2008;122(6):1218–22.CrossRefGoogle Scholar
  9. 9.
    Dupuis, Savina EN, Chavoin J-P, Rivière D, Didier A. Evaluation of quality of life and respiratory function in patients with pectus excavatum. ERS Int Congr; 2017. Milan Themat Poster.Google Scholar
  10. 10.
    Neviere R, Benhamed L, Duva Pentiah A, Wurtz A. Pectus excavatum repair improves respiratory pump efficacy and cardiovascular function at exercise. J Thorac Cardiovasc Surg. 2013;145(2):605–6.CrossRefGoogle Scholar
  11. 11.
    Sigalet DL, Montgomery M, Harder J. Cardiopulmonary effects of closed repair of pectus excavatum. J Pediatr Surg. 2003;38(3):380–5; discussion 380–5.CrossRefGoogle Scholar
  12. 12.
    Kelly RE, Shamberger RC, Mellins RB, Mitchell KK, Lawson ML, Oldham K, et al. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg. 2007;205(2):205–16.CrossRefGoogle Scholar
  13. 13.
    Fonkalsrud EW. 912 open pectus excavatum repairs: changing trends, lessons learned: one surgeon’s experience. World J Surg. 2009;33(2):180–90.CrossRefGoogle Scholar
  14. 14.
    Kragten HA, Siebenga J, Höppener PF, Verburg R, Visker N. Symptomatic pectus excavatum in seniors (SPES): a cardiovascular problem?: a prospective cardiological study of 42 senior patients with a symptomatic pectus excavatum. Neth Heart J. 2011;19(2):73–8.CrossRefGoogle Scholar
  15. 15.
    Kelly RE, Goretsky MJ, Obermeyer R, Kuhn MA, Redlinger R, Haney TS, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252(6):1072–81.CrossRefGoogle Scholar
  16. 16.
    Koumbourlis AC, Stolar CJ. Lung growth and function in children and adolescents with idiopathic pectus excavatum. Pediatr Pulmonol. 2004;38(4):339–43.CrossRefGoogle Scholar
  17. 17.
    Coskun ZK, Turgut HB, Demirsoy S, Cansu A. The prevalence and effects of pectus excavatum and pectus carinatum on the respiratory function in children between 7-14 years old. Indian J Pediatr. 2010;77(9):1017–9.CrossRefGoogle Scholar
  18. 18.
    Lawson ML, Mellins RB, Paulson JF, Shamberger RC, Oldham K, Azizkhan RG, et al. Increasing severity of pectus excavatum is associated with reduced pulmonary function. J Pediatr. 2011;159(2):256–261.e2.CrossRefGoogle Scholar
  19. 19.
    Chen Z, Amos EB, Luo H, Su C, Zhong B, Zou J, et al. Comparative pulmonary functional recovery after Nuss and Ravitch procedures for pectus excavatum repair: a meta-analysis. J Cardiothorac Surg. 2012;7:101.CrossRefGoogle Scholar
  20. 20.
    Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–68.CrossRefGoogle Scholar
  21. 21.
    Malek MH, Fonkalsrud EW, Cooper CB. Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest. 2003;124(3):870–82.CrossRefGoogle Scholar
  22. 22.
    Quigley PM, Haller JA, Jelus KL, Loughlin GM, Marcus CL. Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr. 1996;128(5 Pt 1):638–43.CrossRefGoogle Scholar
  23. 23.
    Kowalewski J. Cardiorespiratory function before and after operation for pectus excavatum: medium-term results. Eur J Cardiothorac Surg. 1998;13(3):275–9.Google Scholar
  24. 24.
    Krueger T, Chassot P-G, Christodoulou M, Cheng C, Ris H-B, Magnusson L. Cardiac function assessed by transesophageal echocardiography during pectus excavatum repair. Ann Thorac Surg. 2010;89(1):240–3.CrossRefGoogle Scholar
  25. 25.
    Huang P-M, Liu C-M, Cheng Y-J, Kuo S-W, Wu E-T, Lee Y-C. Evaluation of intraoperative cardiovascular responses to closed repair for pectus excavatum. Thorac Cardiovasc Surg. 2008;56(6):353–8.CrossRefGoogle Scholar
  26. 26.
    Mocchegiani R, Badano L, Lestuzzi C, Nicolosi GL, Zanuttini D. Relation of right ventricular morphology and function in pectus excavatum to the severity of the chest wall deformity. Am J Cardiol. 1995;76(12):941–6.CrossRefGoogle Scholar
  27. 27.
    O’Keefe J, Byrne R, Montgomery M, Harder J, Roberts D, Sigalet DL. Longer term effects of closed repair of pectus excavatum on cardiopulmonary status. J Pediatr Surg. 2013;48(5):1049–54.CrossRefGoogle Scholar
  28. 28.
    Tardy MM, Tardy-Médous MM, Filaire M, Patoir A, Gautier-Pignonblanc P, Galvaing G, et al. Exercise cardiac output limitation in pectus excavatum. J Am Coll Cardiol. 2015;66(8):976–7.CrossRefGoogle Scholar
  29. 29.
    Borowitz D, Cerny F, Zallen G, Sharp J, Burke M, Gross K, et al. Pulmonary function and exercise response in patients with pectus excavatum after Nuss repair. J Pediatr Surg. 2003;38(4):544–7.CrossRefGoogle Scholar
  30. 30.
    Udholm S, Maagaard M, Pilegaard H, Hjortdal V. Cardiac function in adults following minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg. 2016;22(5):525–9.CrossRefGoogle Scholar
  31. 31.
    Castellani C, Schalamon J, Saxena AK, Höellwarth ME. Early complications of the Nuss procedure for pectus excavatum: a prospective study. Pediatr Surg Int. 2008;24(6):659–66.CrossRefGoogle Scholar
  32. 32.
    Morshuis WJ, Folgering HT, Barentsz JO, Cox AL, van Lier HJ, Lacquet LK. Exercise cardiorespiratory function before and one year after operation for pectus excavatum. J Thorac Cardiovasc Surg. 1994;107(6):1403–9.CrossRefGoogle Scholar
  33. 33.
    Neviere R, Montaigne D, Benhamed L, Catto M, Edme JL, Matran R, et al. Cardiopulmonary response following surgical repair of pectus excavatum in adult patients. Eur J Cardiothorac Surg. 2011;40(2):e77–82.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Sigalet DL, Montgomery M, Harder J, Wong V, Kravarusic D, Alassiri A. Long term cardiopulmonary effects of closed repair of pectus excavatum. Pediatr Surg Int. 2007;23(5):493–7.CrossRefGoogle Scholar
  35. 35.
    Cahill JL, Lees GM, Robertson HT. A summary of preoperative and postoperative cardiorespiratory performance in patients undergoing pectus excavatum and carinatum repair. J Pediatr Surg. 1984;19(4):430–3.CrossRefGoogle Scholar
  36. 36.
    Lomholt JJ, Jacobsen EB, Thastum M, Pilegaard H. A prospective study on quality of life in youths after pectus excavatum correction. Ann Cardiothorac Surg. 2016;5(5):456–65.CrossRefGoogle Scholar
  37. 37.
    Kim HK, Shim JH, Choi KS, Choi YH. The quality of life after bar removal in patients after the nuss procedure for pectus excavatum. World J Surg. 2011;35(7):1656–61.CrossRefGoogle Scholar
  38. 38.
    Ji Y, Liu W, Chen S, Xu B, Tang Y, Wang X, et al. Assessment of psychosocial functioning and its risk factors in children with pectus excavatum. Health Qual Life Outcomes. 2011;9:28.CrossRefGoogle Scholar
  39. 39.
    Chavoin J-P, Grolleau J-L, Moreno B, Brunello J, André A, Dahan M, et al. Correction of pectus excavatum by custom-made silicone implants: contribution of computer-aided design reconstruction. A 20-year experience and 401 cases. Plast Reconstr Surg. 2016;137(5):860e–71e.CrossRefGoogle Scholar
  40. 40.
    Steinmann C, Krille S, Mueller A, Weber P, Reingruber B, Martin A. Pectus excavatum and pectus carinatum patients suffer from lower quality of life and impaired body image: a control group comparison of psychological characteristics prior to surgical correction. Eur J Cardiothorac Surg. 2011;40(5):1138–45.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Cobben JM, Oostra R-J, van Dijk FS. Pectus excavatum and carinatum. Eur J Med Genet. 2014;57(8):414–7.CrossRefGoogle Scholar
  42. 42.
    Vogelmeier CF, Criner GJ, Martínez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary. Arch Bronconeumol. 2017;53(3):128–49.CrossRefGoogle Scholar
  43. 43.
    Global initiative for Asthma. Global strategy for asthma management and prevention; 2017.Google Scholar
  44. 44.
    Kelly RE, Lawson ML, Paidas CN, Hruban RH. Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival. J Pediatr Surg. 2005;40(8):1275–8.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Pulmonary DepartmentAlbi HospitalAlbiFrance
  2. 2.Pulmonary DepartmentLarrey Hospital, Toulouse University HospitalToulouseFrance
  3. 3.Pulmunology and Allergology DepartmentLarrey Hospital, Toulouse University HospitalToulouseFrance

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