title: Normalized cardiopulmonary exercise function in patients with pectus excavatum three years after operation.
abstract: BACKGROUND
  During exercise cardiac function is often limited in patients with pectus excavatum. Therefore, we hypothesized that cardiopulmonary exercise function would improve after the Nuss procedure.
  
  
  METHODS
  Seventy-five teenagers (49 patients, 26 controls) were investigated at rest and during bicycle exercise before surgery, and 1 year and 3 years postoperatively (after pectus-bar removal). Echocardiography and lung spirometry were performed at rest. Cardiac output, heart rate, and aerobic exercise capacity were measured using a photoacoustic gas-rebreathing technique during rest and exercise.
  
  
  RESULTS
  Forty-four patients and 26 controls completed 3 years follow-up. Preoperatively, patients had lower maximum cardiac index, mean ± SD, 6.6 ± 1.2 l·min(-1)·m(-2) compared with controls 8.1 ± 1.0 l·min(-1)·m(-2) during exercise (p = 0.0001). One year and 3 years postoperatively, patients' maximum cardiac index had increased significantly and after 3 years there was no difference between patients and controls (8.1 ± 1.2 l·min(-1)·m(-2) and 8.3 ± 1.6 l·min(-1)·m(-2), respectively [p = 0.572]). The maximum oxygen consumption was unchanged. Left ventricular dimensions increased in patients over 3 years; however, no difference was seen between the 2 groups. Preoperatively, patients had lower forced expiratory volume in the first second of expiration (FEV1; 86% ± 13%) as compared with controls (94% ± 10%), p = 0.009. Postoperatively, no difference was found in FEV1 between the 2 groups.
  
  
  CONCLUSIONS
  Before operation, FEV1 and maximum cardiac index were lower in patients compared with healthy, age-matched controls. One year after, both parameters had increased, although only FEV1 had normalized. After 3 years and bar removal, cardiopulmonary function in patients during exercise had normalized.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Marie
authors.initials: M
authors.lastname: Maagaard
authors.forename: Mariann
authors.initials: M
authors.lastname: Tang
authors.forename: Steffen
authors.initials: S
authors.lastname: Ringgaard
authors.forename: Hans Henrik M
authors.initials: HH
authors.lastname: Nielsen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Frøkiær
authors.forename: Maj
authors.initials: M
authors.lastname: Haubuf
authors.forename: Hans K
authors.initials: HK
authors.lastname: Pilegaard
authors.forename: Vibeke E
authors.initials: VE
authors.lastname: Hjortdal
mesh_terms: D000293:Adolescent; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008168:Lung / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function; D012129:Respiratory Function Tests / Q000379:methods; D011795:Surveys and Questionnaires; D013905:Thoracoplasty; D013997:Time Factors; D016896:Treatment Outcome