The Cardiorespiratory Implications of Pectus Excavatum



Pectus excavatum (PE) is the most frequently encountered congenital chest wall abnormality. There is a growing body of evidence about the physiological impact of pectus excavatum with particular reference to cardiorespiratory implications of the condition.However, the reality is the true relevance of this evidence remains to be established. At a time when evidence-based clinical practice has never been more important, the absence of a randomized controlled trial is notable.


  1. 1.
    Tocchioni F, Ghionzoli M, Messineo A, et al. Pectus excavatum and heritable disorders of the connective tissue. Pediatr Rep. 2013;5(3):e15.CrossRefGoogle Scholar
  2. 2.
    Williams AM, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev. 2003;4:237–42.CrossRefGoogle Scholar
  3. 3.
    Tocchioni F, Ghionzoli M, Pepe G, et al. Pectus excavatum and MASS phenotype: an unknown association. J Laparoendosc Adv Surg Tech A. 2012;22:508–13.CrossRefGoogle Scholar
  4. 4.
    Cartoski MJ, Nuss D, Goretsky MJ, et al. Classification of the dysmorphology of pectus excavatum. J Pediatr Surg. 2006;41:1573–81.CrossRefGoogle Scholar
  5. 5.
    Rattan AS, Laor T, Ryckman FC, et al. Pectus excavatum imaging: enough but not too much. Pediatr Radiol. 2012;40:168–72.CrossRefGoogle Scholar
  6. 6.
    Creswick HA, Stacey MW, Kelly RE Jr, et al. Family study of the inheritance of pectus excavatum. J Pediatr Surg. 2006;41:1699–703.CrossRefGoogle Scholar
  7. 7.
    Jaroszewski D, Notrica D, McMahon L, et al. Current management of pectus excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23:230–9.CrossRefGoogle Scholar
  8. 8.
    Redlinger RE Jr, Rushing GD, Moskowitz AD, et al. Minimally invasive repair of pectus excavatum in patients with Marfan syndrome and marfanoid features. J Pediatr Surg. 2010;45:193–9.CrossRefGoogle Scholar
  9. 9.
    Ho NC, Tran JR, Bektas A. Marfan’s syndrome. Lancet. 2005;366:1978–81.CrossRefGoogle Scholar
  10. 10.
    Le Parc JM, Molcard S, Tubach F, et al. Marfan syndrome and fibrillin disorders. Joint Bone Spine. 2000;67:401–7.PubMedGoogle Scholar
  11. 11.
    Colombani PM. Preoperative assessment of chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;21:58–63.CrossRefGoogle Scholar
  12. 12.
    Jayaramakrishnan K, Wotton R, Bradley A, et al. Does repair of pectus excavatum improve cardiopulmonary function? Interact Cardiovasc Thorac Surg. 2013;16(6):865–70.CrossRefGoogle Scholar
  13. 13.
    Malek MH, Berger DE, Marelich WD, et al. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg. 2006;30:637–43.CrossRefGoogle Scholar
  14. 14.
    Malek MH, Berger DE, Housh TJ, et al. Cardiovascular function following surgical repair of pectus excavatum: a meta-analysis. Chest. 2006;130:506–16.CrossRefGoogle Scholar
  15. 15.
    Johnson JN, Hartman TK, Pianosi PT, et al. Cardiorespiratory function after operation for pectus excavatum. J Pediatr. 2008;153:359–64.CrossRefGoogle Scholar
  16. 16.
    Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac compression with the Nuss minimally invasive repair for pectus excavatum. J Pediatr Surg. 2006;41:683–6.CrossRefGoogle Scholar
  17. 17.
    Castellani C, Windhaber J, Schober PH, et al. Exercise performance testing in patients with pectus excavatum before and after Nuss procedure. Pediatr Surg Int. 2010;26:659–63.CrossRefGoogle Scholar
  18. 18.
    Tang M, Nielson HH, Lesbo M, et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg. 2012;41:1063–7.CrossRefGoogle Scholar
  19. 19.
    Sigalet DL, Montgomery M, Harder J, et al. Long term cardiopulmonary effects of closed repair of pectus excavatum. Pediatr Surg Int. 2007;23:493–7.CrossRefGoogle Scholar
  20. 20.
    Acosta J, Bradley A, Raja V, et al. Exercise improvement after pectus excavatum repair is not related to chest wall function. Eur J Cardiothorac Surg. 2014;45(3):544–8.CrossRefGoogle Scholar
  21. 21.
    Sigalet DL, Montgomery M, Harder J. Cardiopulmonary effects of closed repair of pectus excavatum. J Pediatr Surg. 2003;38:380–5.CrossRefGoogle Scholar
  22. 22.
    Borowitz D, Cerny F, Zallen G, et al. Pulmonary function and exercise response in patients with pectus excavatum after Nuss repair. J Pediatr Surg. 2003;38:544–7.CrossRefGoogle Scholar
  23. 23.
    Lawson ML, Mellins RB, Tabangin M, et al. Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure. J Pediatr Surg. 2005;40:174–80.CrossRefGoogle Scholar
  24. 24.
    Bawazir OA, Montgomery M, Harder J, et al. Midterm evaluation of cardiopulmonary effects of closed repair for pectus excavatum. J Pediatr Surg. 2005;40:863–7.CrossRefGoogle Scholar
  25. 25.
    Udholm S, Maagaard M, Pilegaard H, et al. Cardiac function in adults following minimally invasive repair of pectus excavatum. Interact Cardiovasc Thorac Surg. 2016;22(5):525–9.CrossRefGoogle Scholar
  26. 26.
    Chao CJ, Dawn Jaroszewski D, Gotway M, et al. Effects of pectus excavatum repair on right and left ventricular strain. Ann Thorac Surg. 2018;105:294–301.CrossRefGoogle Scholar
  27. 27.
    Topper A, Polleichtner S, Zagrosek A, et al. Impact of surgical correction of pectus excavatum on cardiac function: insights on the right ventricle. A cardiovascular magnetic resonance study. Interact Cardiovasc Thorac Surg. 2016;22:38–46.CrossRefGoogle Scholar
  28. 28.
    Nuss D. Minimally invasive surgical repair of pectus excavatum. Semin Pediatr Surg. 2008;17:209–17.CrossRefGoogle Scholar
  29. 29.
    Jaroszewski DE, Fonkalsrud EW. Repair of pectus chest wall deformities in 320 adult patients: 21-year experience. Ann Thorac Surg. 2007;84:429–33.CrossRefGoogle Scholar
  30. 30.
    Jaroszewski DE. Physiologic implications of pectus excavatum. J Thorac Cardiovasc Surg. 2017;153:218–9.CrossRefGoogle Scholar
  31. 31.
    Chao CJ, Jaroszewski DE, Kumar PN, 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;210:1118–24; discussion 1124–5.CrossRefGoogle Scholar
  32. 32.
    Quigley PM, Haller JA Jr, Jelus KL, et al. Cardiorespiratory function before and after corrective surgery in pectus excavatum. J Pediatr. 1996;128:638–43.CrossRefGoogle Scholar
  33. 33.
    Winkens R, Guldemond F, Hoppener P, et al. Pectus excavatum, not always as harmless as it seems. BMJ Case Rep. 2009.Google Scholar
  34. 34.
    Jaroszewski D, Steidley E, Galindo A, et al. Treating heart failure and dyspnoea in a 78-year-old man with surgical correction of pectus excavatum. Ann Thorac Surg. 2009;88:1008–10.CrossRefGoogle Scholar
  35. 35.
    Kragten HA, Siebenga J, Höppener PF, et al. 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;19:73–8.CrossRefGoogle Scholar
  36. 36.
    Gyllensward A, Irnell L, Michaelsson M, et al. Pectus excavatum. A clinical study with long term postoperative follow-up. Acta Paediatr Scand. 1975;255(Suppl):1–14.CrossRefGoogle Scholar
  37. 37.
    Chavoin JP, Grolleau JL, Moreno B, 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;137:860e–71e.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Essex Cardiothoracic CentreBasildonUK

Personalised recommendations