Original article
General thoracic
Cardiac Function Assessed by Transesophageal Echocardiography During Pectus Excavatum Repair

https://doi.org/10.1016/j.athoracsur.2009.06.126Get rights and content

Background

We assessed end-diastolic right ventricular (RV) dimensions and left ventricular (LV) ejection fraction by use of intraoperative transesophageal echocardiography before and after surgical correction of pectus excavatum in adults.

Methods

A prospective study was conducted including 17 patients undergoing surgical correction of pectus excavatum according to the technique of Ravitch-Shamberger between 1999 and 2004. Intraoperative transesophageal echocardiography was performed under general anesthesia before and after surgery to assess end-diastolic RV dimensions and LV ejection fraction. The end-diastolic RV diameter and area were measured in four-chamber and RV inflow-outflow view, and the RV volume was calculated from these data. The LV was assessed by transgastric short-axis view, and its ejection fraction was calculated by use of the Teichholz formula.

Results

The end-diastolic RV diameter, area, and volume all significantly increased after surgery (mean values ± SD, respectively: 2.4 ± 0.8 cm versus 3.0 ± 0.9 cm, p < 0.001; 12.5 ± 5.2 cm2 versus 18.4 ± 7.5 cm2, p < 0.001; and 21.7 ± 11.7 mL versus 40.8 ± 23 mL, p < 0.001). The LV ejection fraction also significantly increased after surgery (58.4% ± 15% versus 66.2% ± 6%, p < 0.001).

Conclusions

Surgical correction of pectus excavatum according to Ravitch-Shamberger technique results in a significant increase in end-diastolic RV dimensions and a significantly increased LV ejection fraction.

Section snippets

Patients

In this prospective study, all patients operated on between 1999 and 2004 at our institution underwent intraoperative TEE with evaluation of RV dimensions and LVEF before and after surgical correction of their pectus excavatum deformity. Seventeen adult patients were assessed, 13 male and 4 female, with a mean age of 28 years (range, 17 to 54). All patients expressed a variety of symptoms mainly related to impaired exercise tolerance and aesthetic concerns. The study was reviewed and approved

Results

The mean values of the end-diastolic RV dimensions and of the LVEFs before and after surgical correction of pectus excavatum are summarized in Table 1. The end-diastolic RV diameter, area, and volume all significantly increased after surgery (p < 0.001). Intraoperative TEE revealed that all patients had a marked RV compression and deformation exerted by sternal depression before surgical correction, which was alleviated by surgical correction (Fig 2). It also revealed that the most important

Comment

Surgical correction of pectus excavatum usually results in improved self-confidence and increased stamina in young adults in most reports, but it remains controversial and a matter of debate whether this is accompanied by a gain in cardiopulmonary reserves. A recently published meta-analysis indicates that surgical repair of pectus excavatum does not significantly improve pulmonary function [8]. In contrast, a meta-analysis from the same authors including eight studies published between 1960

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