title: Pulmonary function before and after the Nuss procedure in adolescents with pectus excavatum: correlation with morphological subtypes.
abstract: BACKGROUND
  Differences in post-Nuss procedure pulmonary function based on the pectus excavatum subtype have not been investigated in adolescents. We evaluated differences in pulmonary function before and after the Nuss procedure according to preoperative morphology.
  
  
  METHODS
  We performed a retrospective review of eighteen male patients who had undergone the Nuss procedures. There were nine patients each with symmetric and asymmetric morphology. Patients were younger than 18 years and had no history of respiratory diseases. Pulmonary function was assessed 2 weeks before and 4-6 months after the surgery. Preoperative and postoperative pulmonary function data were compared between the symmetric and asymmetric types. The paired t-test was used to compare the differences within each group and an analysis of covariance (ANCOVA) was used to access intergroup differences.
  
  
  RESULTS
  There were no significant demographic differences between patients with symmetric and asymmetric subtypes. Patients with the asymmetric type had a lower preoperative total lung capacity (TLC) (p = 0.018), vital capacity (VC) (p = 0.0308), and inspiratory capacity (IC) (p = 0.0373). In both types, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and VC were all significantly decreased postoperatively compared to baseline (all, p < 0.01). The asymmetric type showed further reductions in peak expiratory flow (PEF) (p = 0.0391) and IC (p = 0.0084) postoperatively. The residual volume (RV) (p = 0.0092) and RV/TLC ratio (p = 0.0025) increased significantly in the asymmetric type, but only the postoperative PEF values differed significantly between the two types (p = 0.0151).
  
  
  CONCLUSIONS
  The asymmetric type had poorer preoperative lung volumes and poorer postoperative pulmonary function, with significantly lower PEF compared to the symmetric type cases. Preoperative and postoperative lung function needs more careful evaluation until pectus bar removal in the asymmetric type of pectus excavatum.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. jeong74@catholic.ac.kr.
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. ajhcmcim@catholic.ac.kr.
authors.forename: Joong Hyun
authors.initials: JH
authors.lastname: Ahn
authors.affiliation: Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea. sykim2010@catholic.ac.kr.
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea. yoonhong76@gmail.com.
authors.forename: Yoon Hong
authors.initials: YH
authors.lastname: Chun
authors.affiliation: Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea. hkd917@naver.com.
authors.forename: Kyungdo
authors.initials: K
authors.lastname: Han
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. sungbo@catholic.ac.kr.
authors.forename: Sung Bo
authors.initials: SB
authors.lastname: Sim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. khjo@catholic.ac.kr.
authors.forename: Keon Hyon
authors.initials: KH
authors.lastname: Jo
mesh_terms: D000293:Adolescent; D005660:Funnel Chest / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D019637:Orthopedic Procedures; D011184:Postoperative Period; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D016896:Treatment Outcome