Download PDF
Thorac Cardiovasc Surg 2020; 68(01): 085-091
DOI: 10.1055/s-0039-1683384
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

Improved Dynamics of Thoracic Cage and Exercise Capacity after Nuss Repair for Pectus Excavatum

Shu-Wei Yeh
1   Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
,
Mei-Chen Yang
2   School of Medicine, Tzu Chi University, Hualien, Taiwan
3   Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
,
Yi-Wei Chang
2   School of Medicine, Tzu Chi University, Hualien, Taiwan
4   Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
,
Yu-Ting Hsu
4   Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
,
I-Shiang Tzeng
5   Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
,
Yeung-Leung Cheng
1   Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
2   School of Medicine, Tzu Chi University, Hualien, Taiwan
› Author Affiliations
Further Information

Publication History

26 October 2018

28 January 2019

Publication Date:
12 March 2019 (online)

   Permissions and Reprints All articles of this category

Abstract

Background Pectus excavatum (PE) reduces the dynamics of the thoracic cage, with a negative impact on exercise capacity. We aimed to evaluate the effects of Nuss repair for PE on the dynamics of the thoracic cage and exercise capacity in adults.

Methods This was a prospective observational study of 46 adults (mean age, 26.2 years) who underwent PE correction using the Nuss procedure between September 2016 and August 2017. Cirtometry was used to obtain measures of thoracic cage circumference at two levels (axillary level [AL] and xyphoid level [XL]), at the end points of inspiration and expiration. Circumference measures were obtained before surgery and at 1, 3, and 6 months after surgery. Exercise capacity was also evaluated using the 6-minute walk test (6MWT). The association between the 6MWT data and cirtometry measures was evaluated using Pearson's correlation.

Results The circumference at maximum inspiration increased from baseline to 3 months after surgery (p < 0.01), at both the AL (84.5 ± 4.9 vs. 88.5 ± 5.1 cm) and XL (80.1 ± 4.8 vs. 83.7 ± 5.1 cm). The 6MWT also significantly improved from baseline to 3 months after surgical correction (544.7 ± 64.1 vs. 637.3 ± 59.4 m, p < 0.01), with this improvement being correlated to the increase in thoracic circumference on maximal inspiration at both the AL and XL (0.8424 and 0.7951, respectively).

Conclusion Improved dynamics of the thoracic cage were achieved after Nuss repair for PE in adults. This increase in thoracic circumference at maximum inspiration was associated with an improvement in exercise capacity at 3 months after surgery.

Keywords

pectus excavatum - Nuss procedure - thoracic cage - cirtometry - 6-minute walk test

Financial Support

This work was not supported by any funding agency.


 

  • References

  • 1 Brochhausen C, Turial S, Müller FK. , et al. Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg 2012; 14 (06) 801-806
    CrossrefPubMedGoogle Scholar
  • 2 Nuss D, Kelly Jr RE. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin 2010; 20 (04) 583-597
    CrossrefPubMedGoogle Scholar
  • 3 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 (02) 73-78
    CrossrefPubMedGoogle Scholar
  • 4 Jaroszewski DE, Ewais MM, Chao CJ. , et al. Success of minimally invasive pectus excavatum procedures (modified Nuss) in adult patients (≥30 years). Ann Thorac Surg 2016; 102 (03) 993-1003
    CrossrefPubMedGoogle Scholar
  • 5 Nuss D, Kelly Jr RE, Croitoru DP, Katz ME. A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J Pediatr Surg 1998; 33 (04) 545-552
    CrossrefPubMedGoogle Scholar
  • 6 Maagaard M, Tang M, Ringgaard S. , et al. Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation. Ann Thorac Surg 2013; 96 (01) 272-278
    CrossrefPubMedGoogle Scholar
  • 7 Tang M, Nielsen HH, Lesbo M. , et al. Improved cardiopulmonary exercise function after modified Nuss operation for pectus excavatum. Eur J Cardiothorac Surg 2012; 41 (05) 1063-1067
    CrossrefPubMedGoogle Scholar
  • 8 Malek MH, Berger DE, Marelich WD, Coburn JW, Beck TW, Housh TJ. Pulmonary function following surgical repair of pectus excavatum: a meta-analysis. Eur J Cardiothorac Surg 2006; 30 (04) 637-643
    CrossrefPubMedGoogle Scholar
  • 9 Malek MH, Berger DE, Housh TJ, Marelich WD, Coburn JW, Beck TW. Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis. Chest 2006; 130 (02) 506-516
    CrossrefPubMedGoogle Scholar
  • 10 Debouche S, Pitance L, Robert A, Liistro G, Reychler G. Reliability and reproducibility of chest wall expansion measurement in young healthy adults. J Manipulative Physiol Ther 2016; 39 (06) 443-449
    CrossrefPubMedGoogle Scholar
  • 11 Caldeira VdaS, Starling CC, Britto RR, Martins JA, Sampaio RF, Parreira VF. Reliability and accuracy of cirtometry in healthy adults. J Bras Pneumol 2007; 33 (05) 519-526
    CrossrefPubMedGoogle Scholar
  • 12 Rasekaba T, Lee AL, Naughton MT, Williams TJ, Holland AE. The six-minute walk test: a useful metric for the cardiopulmonary patient. Intern Med J 2009; 39 (08) 495-501
    CrossrefPubMedGoogle Scholar
  • 13 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166 (01) 111-117
    CrossrefPubMedGoogle Scholar
  • 14 Haller Jr JA, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg 1987; 22 (10) 904-906
    CrossrefPubMedGoogle Scholar
  • 15 Wu TH, Huang TW, Hsu HH. , et al. Usefulness of chest images for the assessment of pectus excavatum before and after a Nuss repair in adults. Eur J Cardiothorac Surg 2013; 43 (02) 283-287
    CrossrefPubMedGoogle Scholar
  • 16 Cheng YL, Lee SC, Huang TW, Wu CT. Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum. Eur J Cardiothorac Surg 2008; 34 (05) 1057-1061
    CrossrefPubMedGoogle Scholar
  • 17 Kelly RE, Goretsky MJ, Obermeyer R. , 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 (06) 1072-1081
    CrossrefPubMedGoogle Scholar
  • 18 Sacco Casamassima MG, Gause C, Goldstein SD. , et al. Patient satisfaction after minimally invasive repair of pectus excavatum in adults: long-term results of Nuss procedure in adults. Ann Thorac Surg 2016; 101 (04) 1338-1345
    CrossrefPubMedGoogle Scholar
  • 19 Chang PY, Zeng Q, Wong KS. , et al. A cross-sectional study of chest wall development in patients with pectus excavatum. Thorac Cardiovasc Surg 2015; 63 (05) 433-436
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Kilda A, Lukosevicius S, Barauskas V, Jankauskaite Z, Basevicius A. Radiological changes after Nuss operation for pectus excavatum. Medicina (Kaunas) 2009; 45 (09) 699-705
    CrossrefPubMedGoogle Scholar
  • 21 Nakagawa Y, Uemura S, Nakaoka T, Yano T, Tanaka N. Evaluation of the Nuss procedure using pre- and postoperative computed tomographic index. J Pediatr Surg 2008; 43 (03) 518-521
    CrossrefPubMedGoogle Scholar
  • 22 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 (03) 544-548
    CrossrefPubMedGoogle Scholar
  • 23 Redlinger Jr RE, Wootton A, Kelly RE. , et al. Optoelectronic plethysmography demonstrates abrogation of regional chest wall motion dysfunction in patients with pectus excavatum after Nuss repair. J Pediatr Surg 2012; 47 (01) 160-164
    CrossrefPubMedGoogle Scholar
  • 24 Moll JM, Wright V. An objective clinical study of chest expansion. Ann Rheum Dis 1972; 31 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 25 Grubisić F, Grazio S, Balenović A, Nemcić T, Kusić Z. Osteoporosis, spinal mobility and chest expansion index in patients with ankylosing spondylitis. Coll Antropol 2014; 38 (01) 63-68
    PubMedGoogle Scholar
  • 26 Johansson EL, Ternesten-Hasséus E, Olsén MF, Millqvist E. Respiratory movement and pain thresholds in airway environmental sensitivity, asthma and COPD. Respir Med 2012; 106 (07) 1006-1013
    CrossrefPubMedGoogle Scholar
  • 27 Malaguti C, Rondelli RR, de Souza LM, Domingues M, Dal Corso S. Reliability of chest wall mobility and its correlation with pulmonary function in patients with chronic obstructive pulmonary disease. Respir Care 2009; 54 (12) 1703-1711
    PubMedGoogle Scholar
  • 28 Lanza FdeC, de Camargo AA, Archija LR, Selman JP, Malaguti C, Dal Corso S. Chest wall mobility is related to respiratory muscle strength and lung volumes in healthy subjects. Respir Care 2013; 58 (12) 2107-2112
    CrossrefPubMedGoogle Scholar
  • 29 Wang Q, Fan S, Wu C, Jin X, Pan Z, Hong D. Changes in resting pulmonary function testing over time after the Nuss procedure: a systematic review and meta-analysis. J Pediatr Surg 2018; 53 (11) 2299-2306
    CrossrefPubMedGoogle Scholar