Ventilatory limitations are not associated with dyspnea on exertion or
reduced aerobic fitness in pectus excavatum
Pulmonary defects are reported in pectus excavatum but the physiological
impact on exercise capacity is unclear. To test the hypothesis that
pectus deformities are associated with a pulmonary impairment during
exercise we performed a retrospective review on pectus patients in our
center who completed a symptom questionnaire, cardiopulmonary exercise
test, pulmonary function tests (PFT), and chest magnetic resonance
imaging. Of 259 patients studied, dyspnea on exertion and chest pain was
reported in 64% and 41% respectively. Peak oxygen uptake (VO2) was
reduced in 30% and classified as mild in two-thirds. A pulmonary
limitation during exercise was identified in less than 3%. Ventilatory
limitations on PFT was found in 26% and classified as mild in 85%.
Obstruction was the most common abnormal pattern (11%) followed by a
nonspecific ventilatory limitation and restrictive pattern (7% each).
There were no differences between patients with normal or abnormal PFT
patterns for the anatomic degree of pectus malformation, VO2, or
percentage reporting dyspnea or chest pain. Scatter plots demonstrated
significant inverse relationships between severity of the pectus
deformity with lung volumes on PFT and VO2 but no correlation between
the severity of the pectus deformity and lung volumes during exercise.
We conclude that resting lung volume measurements were associated with
the anatomic degree of pectus severity but respiratory limitations
during maximal exercise are uncommon and PFT patterns have poor
correlation with symptomatology or VO2. These findings suggest
non-respiratory causes are more likely for the high rates of dyspnea and
reduced aerobic fitness reported in pectus.