Increasing severity of pectus excavatum is associated with reduced pulmonary function

M. Louise Lawson, Robert B. Mellins, James F. Paulson, Robert C. Shamberger, Keith Oldham, Richard G. Azizkhan, Andre V. Hebra, Donald Nuss, Michael J. Goretsky, Ronald J. Sharp, George W. Holcomb, Walton K T Shim, Stephen M. Megison, R. Lawrence Moss, Annie H. Fecteau, Paul M. Colombani, Alan B. Moskowitz, Joshua Hill, Robert E. Kelly

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. Study design: We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. Results: The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV1/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV1 <80% predicted; FEV1/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. Conclusions: Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume159
Issue number2
DOIs
StatePublished - Aug 2011

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Funnel Chest
Lung
Vital Capacity
Exhalation
Forced Expiratory Volume
Total Lung Capacity
Spirometry
Multicenter Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lawson, M. L., Mellins, R. B., Paulson, J. F., Shamberger, R. C., Oldham, K., Azizkhan, R. G., ... Kelly, R. E. (2011). Increasing severity of pectus excavatum is associated with reduced pulmonary function. Journal of Pediatrics, 159(2). https://doi.org/10.1016/j.jpeds.2011.01.065

Increasing severity of pectus excavatum is associated with reduced pulmonary function. / Lawson, M. Louise; Mellins, Robert B.; Paulson, James F.; Shamberger, Robert C.; Oldham, Keith; Azizkhan, Richard G.; Hebra, Andre V.; Nuss, Donald; Goretsky, Michael J.; Sharp, Ronald J.; Holcomb, George W.; Shim, Walton K T; Megison, Stephen M.; Moss, R. Lawrence; Fecteau, Annie H.; Colombani, Paul M.; Moskowitz, Alan B.; Hill, Joshua; Kelly, Robert E.

In: Journal of Pediatrics, Vol. 159, No. 2, 08.2011.

Research output: Contribution to journalArticle

Lawson, ML, Mellins, RB, Paulson, JF, Shamberger, RC, Oldham, K, Azizkhan, RG, Hebra, AV, Nuss, D, Goretsky, MJ, Sharp, RJ, Holcomb, GW, Shim, WKT, Megison, SM, Moss, RL, Fecteau, AH, Colombani, PM, Moskowitz, AB, Hill, J & Kelly, RE 2011, 'Increasing severity of pectus excavatum is associated with reduced pulmonary function', Journal of Pediatrics, vol. 159, no. 2. https://doi.org/10.1016/j.jpeds.2011.01.065
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. Journal of Pediatrics. 2011 Aug;159(2). https://doi.org/10.1016/j.jpeds.2011.01.065
Lawson, M. Louise ; Mellins, Robert B. ; Paulson, James F. ; Shamberger, Robert C. ; Oldham, Keith ; Azizkhan, Richard G. ; Hebra, Andre V. ; Nuss, Donald ; Goretsky, Michael J. ; Sharp, Ronald J. ; Holcomb, George W. ; Shim, Walton K T ; Megison, Stephen M. ; Moss, R. Lawrence ; Fecteau, Annie H. ; Colombani, Paul M. ; Moskowitz, Alan B. ; Hill, Joshua ; Kelly, Robert E. / Increasing severity of pectus excavatum is associated with reduced pulmonary function. In: Journal of Pediatrics. 2011 ; Vol. 159, No. 2.
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abstract = "Objective: To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. Study design: We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. Results: The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow from 25{\%} exhalation to 75{\%} exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2{\%} of patients demonstrated an obstructive pattern (FEV1/FVC <67{\%}), and 14.5{\%} demonstrated a restrictive pattern (FVC and FEV1 <80{\%} predicted; FEV1/FVC >80{\%}). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80{\%} than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. Conclusions: Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.",
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AU - Azizkhan, Richard G.

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AU - Nuss, Donald

AU - Goretsky, Michael J.

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AU - Holcomb, George W.

AU - Shim, Walton K T

AU - Megison, Stephen M.

AU - Moss, R. Lawrence

AU - Fecteau, Annie H.

AU - Colombani, Paul M.

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N2 - Objective: To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. Study design: We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. Results: The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV1/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV1 <80% predicted; FEV1/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. Conclusions: Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.

AB - Objective: To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study. Study design: We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function. Results: The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV1/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV1 <80% predicted; FEV1/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern. Conclusions: Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.

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