Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH, 45229, USA.
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
Pediatr Surg Int. 2020 Nov;36(11):1281-1286. doi: 10.1007/s00383-020-04738-5. Epub 2020 Sep 17.
Pectus excavatum (PE) is a chest wall deformity of variable severity and symptomatology. Existing female-specific literature highlights breast asymmetry and cosmetic reconstruction. We sought to evaluate gender differences in cardiopulmonary function.
Cardiac MRIs, pulmonary function tests (PFTs), and cardiopulmonary exercise tests (CPETs) were reviewed in 345 patients undergoing preoperative evaluation for PE. Regression modeling was used to evaluate associations between gender and clinical endpoints of cardiopulmonary function.
Mean age was 15.2 years, 19% were female, 98% were white. Pectus indices included median Haller Index (HI) of 4.8, mean depression index (DI) of 0.63, correction index (CI) of 33.6%, and Cardiac Compression Index (CCI) of 2.79. Cardiac assessment revealed decreased right and left ventricular ejection fraction (RVEF, LVEF) in 16% and 22% of patients, respectively. PFTs and CPETs were abnormal in ~ 30% of patients. While females had deeper PE deformities-represented by higher pectus indices-they had superior function with higher RVEF, LVEF Z-scores, FEV, VO max, O pulse, work, and breathing reserve (p < 0.05).
Despite worse PE deformity and symptomatology, females had a better cardiopulmonary function and exercise tolerance than males. Further research is needed to assess the precise mechanisms of this phenomenon and postoperative outcomes in this population.
漏斗胸（PE）是一种严重程度和症状表现不一的胸廓畸形。现有的女性特有的文献强调了乳房不对称和美容重建。我们旨在评估心肺功能的性别差异。
回顾了 345 例接受 PE 术前评估的患者的心脏 MRI、肺功能测试（PFT）和心肺运动测试（CPET）。回归模型用于评估性别与心肺功能临床终点之间的关联。
平均年龄为 15.2 岁，19%为女性，98%为白人。胸廓指数包括中位数 Haller 指数（HI）为 4.8，平均凹陷指数（DI）为 0.63，校正指数（CI）为 33.6%，以及心脏压迫指数（CCI）为 2.79。心脏评估显示，分别有 16%和 22%的患者出现右心室和左心室射血分数（RVEF、LVEF）降低。约 30%的患者的 PFT 和 CPET 异常。尽管女性的 PE 畸形程度更深——表现为更高的胸廓指数——但她们的 RVEF、LVEF Z 分数、FEV、VOmax、O 脉冲、功和呼吸储备更高，功能和运动耐量更好（p<0.05）。
尽管女性的 PE 畸形和症状更严重，但她们的心肺功能和运动耐量优于男性。需要进一步研究来评估这种现象的确切机制以及该人群的术后结果。
