title: Increasing severity of pectus excavatum is associated with reduced pulmonary function.
abstract: OBJECTIVE
  To determine whether pulmonary function decreases as a function of severity of pectus excavatum, and whether reduced function is restrictive or obstructive in nature in a large multicenter study.
  
  
  METHODS
  We evaluated preoperative spirometry data in 310 patients and lung volumes in 218 patients aged 6 to 21 years at 11 North American centers. We modeled the impact of the severity of deformity (based on the Haller index) on pulmonary function.
  
  
  RESULTS
  The percentages of patients with abnormal forced vital capacity (FVC), forced expiratory volume in 1 second (FEV(1)), forced expiratory flow from 25% exhalation to 75% exhalation, and total lung capacity findings increased with increasing Haller index score. Less than 2% of patients demonstrated an obstructive pattern (FEV(1)/FVC <67%), and 14.5% demonstrated a restrictive pattern (FVC and FEV(1) <80% predicted; FEV(1)/FVC >80%). Patients with a Haller index of 7 are >4 times more likely to have an FVC of ≤80% than those with a Haller index of 4, and are also 4 times more likely to exhibit a restrictive pulmonary pattern.
  
  
  CONCLUSIONS
  Among patients presenting for surgical repair of pectus excavatum, those with more severe deformities have a much higher likelihood of decreased pulmonary function with a restrictive pulmonary pattern.
authors.affiliation: Department of Mathematics and Statistics, Kennesaw State University, Kennesaw, GA, USA.
authors.forename: M Louise
authors.initials: ML
authors.lastname: Lawson
authors.forename: Robert B
authors.initials: RB
authors.lastname: Mellins
authors.forename: James F
authors.initials: JF
authors.lastname: Paulson
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: Keith
authors.initials: K
authors.lastname: Oldham
authors.forename: Richard G
authors.initials: RG
authors.lastname: Azizkhan
authors.forename: Andre V
authors.initials: AV
authors.lastname: Hebra
authors.forename: Donald
authors.initials: D
authors.lastname: Nuss
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goretsky
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Sharp
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.forename: Walton K T
authors.initials: WK
authors.lastname: Shim
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Megison
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
authors.forename: Annie H
authors.initials: AH
authors.lastname: Fecteau
authors.forename: Paul M
authors.initials: PM
authors.lastname: Colombani
authors.forename: Alan B
authors.initials: AB
authors.lastname: Moskowitz
authors.forename: Joshua
authors.initials: J
authors.lastname: Hill
authors.forename: Robert E
authors.initials: RE
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005540:Forced Expiratory Flow Rates / Q000502:physiology*; D005660:Funnel Chest / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012720:Severity of Illness Index; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity / Q000502:physiology*; D055815:Young Adult