title: Cardiovascular magnetic resonance in patients with pectus excavatum compared with normal controls.
abstract: OBJECTIVE
  To assess cardiothoracic structure and function in patients with pectus excavatum compared with control subjects using cardiovascular magnetic resonance imaging (CMR).
  
  
  METHODS
  Thirty patients with pectus excavatum deformity (23 men, 7 women, age range: 14-67 years) underwent CMR using 1.5-Tesla scanner (Siemens) and were compared to 25 healthy controls (18 men, 7 women, age range 18-50 years). The CMR protocol included cardiac cine images, pulmonary artery flow quantification, time resolved 3D contrast enhanced MR angiography (CEMRA) and high spatial resolution CEMRA. Chest wall indices including maximum transverse diameter, pectus index (PI), and chest-flatness were measured in all subjects. Left and right ventricular ejection fractions (LVEF, RVEF), ventricular long and short dimensions (LD, SD), mid-ventricle myocardial shortening, pulmonary-systemic circulation time, and pulmonary artery flow were quantified.
  
  
  RESULTS
  In patients with pectus excavatum, the pectus index was 9.3 ± 5.0 versus 2.8 ± 0.4 in controls (P < 0.001). No significant differences between pectus excavatum patients and controls were found in LV ejection fraction, LV myocardial shortening, pulmonary-systemic circulation time or pulmonary flow indices. In pectus excavatum, resting RV ejection fraction was reduced (53.9 ± 9.6 versus 60.5 ± 9.5; P = 0.013), RVSD was reduced (P < 0.05) both at end diastole and systole, RVLD was increased at end diastole (P < 0.05) reflecting geometric distortion of the RV due to sternal compression.
  
  
  CONCLUSIONS
  Depression of the sternum in pectus excavatum patients distorts RV geometry. Resting RVEF was reduced by 6% of the control value, suggesting that these geometrical changes may influence myocardial performance. Resting LV function, pulmonary circulation times and pulmonary vascular anatomy and perfusion indices were no different to controls.
authors.affiliation: Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. roya.saleh@gmail.com
authors.forename: Roya S
authors.initials: RS
authors.lastname: Saleh
authors.forename: J Paul
authors.initials: JP
authors.lastname: Finn
authors.forename: Michael
authors.initials: M
authors.lastname: Fenchel
authors.forename: Abbas Nasirae
authors.initials: AN
authors.lastname: Moghadam
authors.forename: Mayil
authors.initials: M
authors.lastname: Krishnam
authors.forename: Marlon
authors.initials: M
authors.lastname: Abrazado
authors.forename: Anthony
authors.initials: A
authors.lastname: Ton
authors.forename: Reza
authors.initials: R
authors.lastname: Habibi
authors.forename: Eric W
authors.initials: EW
authors.lastname: Fonkalsrud
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003287:Contrast Media; D005260:Female; D005660:Funnel Chest / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D015141:Los Angeles; D018810:Magnetic Resonance Angiography; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000473:pathology / Q000503:physiopathology; D011652:Pulmonary Circulation; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D003287:Contrast Media