Impairment of Cardiac Function in Patients with Pectus Excavatum, with Improvement after Operative Correction

Although pectus excavatum is thought to impair cardiac performance, no consistent hemodynamic abnormalities have been identified. We hypothesized that cardiac function might be impaired during upright exercise when the heart descends into the pectus deformity. Catheterization of the right side of the heart in six patients with pectus excavatum gave normal results, and the hemodynamic response to supine exercise was normal. In contrast, cardiac output (CO) during intense upright exercise was low in two patients, at the lower limits of normal in one, and low normal in two. The CO and stroke-volume responses to mild upright exercise also differed from normal. After operative repair in three patients, CO during intense upright exercise increased an average of 38 per cent, and hemodynamic responses to mild upright exercise also changed toward normal. No alterations occurred in the response to supine exercise. Thus, pectus excavatum can reduce the pumping capacity of the heart during upright exercise, and hemodynamic improvement occurs after surgical correction.