Pulmonary function tests in patients with congenital pectus excavatum

Pectus excavatum (PE) is the most common chest wall malformation. Researchers have not yet reached a consensus on whether PE interferes with normal lung growth.

Study objective: To clarify the effect of the age of onset of clinical manifestation of PE on pulmonary function.

Methods: A comparative analysis of pulmonary function tests was performed in 38 patients with PE before Nuss procedure and before removal of the metal plate. Inclusion criteria: congenital chest wall deformity, Haller index greater than 3.25, compression index less than 0.89, age from 9 to 15 years at the time of Nuss procedure. Exclusion criteria: presence of scoliotic spinal deformity of grade 3 or higher, presence of congenital heart defects, recurrence of PE, presence of verified genetic syndrome or systemic diseases, refusal of the patient or their legal representative to participate in the study. Patients were divided into two groups. The first group included all patients aged 9-11 years with PE who underwent examination and surgical treatment during the study period. The second group included 19 patients with PE using a stratified sampling method.

Results: Prior to Nuss procedure, vital capacity was statistically significantly lower in patients in the second group than in patients in the first group (0.037). The ratio of forced expiratory volume in 1 second to forced vital capacity was statistically significantly lower in the second group (p=0.079), as was the mean forced expiratory flow rate  within the range of 25% to 75% of forced vital capacity (p=0.027). No statistically significant differences in pulmonary function parameters were found between the first and second groups before removal of the metal plate.

Conclusion. The statistically significant differences in parameters of pulmonary function tests between different age groups of patients with PE before Nuss procedure suggest a decline in lung function with age. However, confirming this hypothesis requires a long-term prospective study of patients from childhood to adolescence.