The utility of echocardiography and pulmonary function testing in the preoperative evaluation of pectus excavatum
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Read the article on pubmed.ncbi.nlm.nih.gov ↗Article · Nov 2022 · 1 min read
In brief
In brief
Retrospective study of 119 pectus excavatum patients found low rates of abnormal echocardiography (13%) and pulmonary function tests (17%), with severity indices predicting abnormalities better than symptoms. Routine echocardiography remains recommended for detecting cardiac anomalies, while elevated Correction Index may guide selective pulmonary function testing.
Written by the GCMD Library team from the article.
Purpose: Echocardiography (ECHO) and pulmonary function testing (PFT) are routinely performed during the preoperative evaluation of pectus excavatum (PE). We hypothesized that these investigations may be performed selectively based on patient symptoms and pectus severity.
Methods: A retrospective review of all PE patients who underwent a Nuss procedure during a 15-year period (2004-2018) was conducted. Symptoms, clinical characteristics, ECHO, and PFT results were extracted from the medical chart. PE severity on computed tomography was measured using the Haller Index (HI) and Correction Index (CI), and reported as mean ± SEM. Logistic and linear regression assessed the ability of symptoms and indices to predict abnormal cardiopulmonary test results.
Results: Of 119 patients, 116 patients had symptom documentation, and 74 (64%) had one or more symptoms. HI and CI were 3.8 ± 1.0 and 31.6 ± 10.3, respectively. Of those with ECHO available (111), 14 (13%) were abnormal, and 12 of 14 required cardiology follow-up. Of those with PFT available (90), the results were abnormal in 15 (17%), including 9 (11%) obstructive, 4 (5%) restrictive, and 2 (2%) mixed. The presence of symptoms did not predict abnormal ECHO or PFT, but each standard deviation increase in the CI was associated with abnormal PFT and ECHO by a factor of 2.2 and 2.0 respectively. HI severity was only associated with ECHO.
Conclusion: The rates of abnormal ECHO and PFT testing in PE patients are low, and do not correlate with symptoms. Routine ECHO is still recommended to detect anomalies requiring follow-up. Elevated CI severity may be used to guide selective PFT testing.
DOI: 10.1016/j.jpedsurg.2021.12.010