PURPOSE: Although severe pectus deformities have been shown to cause physiologic and social impairment, many patients do not undergo repair during childhood or adolescence. Several adults subsequently experience progressive worsening of cardiopulmonary function. This study evaluates the symptoms and outcomes of adult pectus patients undergoing repair.
METHODS: A retrospective review from 1986-2005 was performed of 284 patients age 19 or greater who underwent surgical correction of pectus excavatum and carinatum at one university hospital.
RESULTS: Adult patients, including 33 carinatum (12%), 239 excavatum (84%), and 12 combined deformities (4%) underwent surgical correction by open repair with minimal cartilage resection. Twenty-four patients underwent repair of recurrent deformities. Ages ranged from 19-67 years (median 27). All patients experienced symptoms of dyspnea and tachypnea with mild exertion, and most had decreased endurance (n=282, 99%). Tachycardia occurred in 267 patients (94%) and chest pain with exercise in 223 (79%). All patients reported significant worsening of symptoms during adolescence that became more severe during adulthood. The median severity score for PC and PE was 1.8 and 4.5 respectively (range 1.4 - 14.4; normal = 2.5). All patients experienced improvement in endurance, dyspnea, tachypnea, tachycardia and chest pain within 2 - 4 months after repair. Mean hospitalization was 2.9 days. Complications included pleural effusion (n=7), dislodged sternal bar (n=5), pneumothorax (n=3), pericarditis (n=2), and pulmonary embolism (n=1). Mild recurrent depression occurred in 4 patients. There were no deaths. Ninety-eight percent of patients reported considerable improvement in cardiopulmonary symptoms and indicated that the postoperative results were very good or excellent.
CONCLUSION: Pectus deformities persist and often cause worsening symptoms with aging. These abnormalities can be repaired in adults with low morbidity, short hospital stay and considerable improvement in physiologic function.
CLINICAL IMPLICATIONS: Adult patients with severe pectus deformities may exhibit cardiopulmonary compromise. These patients can be safely repaired with improvement of their symptoms.
DISCLOSURE: Dawn Jaroszewski, None.