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Ventilatory limitations are not associated with dyspnea on exertion or reduced aerobic fitness in pectus excavatum
  • +5
  • William Hardie,
  • Adam Powell,
  • Todd Jenkins,
  • Karla Foster,
  • Justin Tretter,
  • Robert Fleck,
  • Victor Garcia,
  • Rebeccah Brown
William Hardie
Childrens Hospital Medical Center
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Adam Powell
Cincinnati Children's Hospital Medical Center
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Todd Jenkins
Cincinnati Children's Hospital Medical Center
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Karla Foster
Cincinnati Children's Hospital Medical Center
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Justin Tretter
Cincinnati Children's Hospital Medical Center
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Robert Fleck
Cincinnati Children's Hospital Medical Center
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Victor Garcia
Cincinnati Children's Hospital Medical Center
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Rebeccah Brown
Cincinnati Children's Hospital Medical Center
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Abstract

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.

Peer review status:ACCEPTED

22 Jan 2021Submitted to Pediatric Pulmonology
23 Jan 2021Submission Checks Completed
23 Jan 2021Assigned to Editor
24 Jan 2021Reviewer(s) Assigned
13 Feb 2021Review(s) Completed, Editorial Evaluation Pending
15 Feb 2021Editorial Decision: Revise Major
26 Apr 20211st Revision Received
27 Apr 2021Submission Checks Completed
27 Apr 2021Assigned to Editor
27 Apr 2021Reviewer(s) Assigned
08 May 2021Review(s) Completed, Editorial Evaluation Pending
08 May 2021Editorial Decision: Revise Minor
22 May 20212nd Revision Received
24 May 2021Assigned to Editor
24 May 2021Reviewer(s) Assigned
24 May 2021Submission Checks Completed
12 Jun 2021Review(s) Completed, Editorial Evaluation Pending
13 Jun 2021Editorial Decision: Accept