PULMONARY-FUNCTION BEFORE SURGERY FOR PECTUS EXCAVATUM AND AT LONG-TERM FOLLOW-UP

Pulmonary function tests were performed before surgery on 152 patients who were operated on for pectus excavatum between 1970 and 1987 and a t long-term follow-up to assess the degree of impairment and to invest igate any changes caused by surgical correction. The mean age at surge ry was 15.3 +/- 5.5 years. Pulmonary function was found to be restrict ed preoperatively. Multivariate analysis showed that preoperative pulm onary function was not related to age, the severity of the deformity a t physical examination, or to pulmonary complaints. Only the patients with obstructive disease showed significantly more pulmonary complaint s (p=0.042). The total lung capacity(TLC) and inspiratory vital capaci ty (IVC) were significantly related to the age-corrected (delta) anter oposterior diameter of the chest (lower vertebral index [LVI]) (p=0.00 01). At follow-up (mean, 8.1 +/- 3.6 years), the restriction of pulmon ary function was increased despite improvement in the symptoms of most patients and despite a significant increase in the anteroposterior di ameter of the chest (p=0.0001): the TLC was decreased from 83.7 percen t predicted (pred) preoperatively to 73.8 percent pred (p=0.0001) and the IVC from 78.3 percent pred to 70.7 percent pred (p=0.0001). The su rgical results were satisfactory in 83.6 percent. No relation was foun d between the changes in pulmonary function measured at follow-up and the surgical results. Only the age at surgery and the changes in the T LC and IVC at follow-up were significantly related (p=0.0036, 0.0043, respectively ), although the correlation coefficients were low (r=27 p ercent and 28 percent, respectively). The reduction in lung function a t follow-up was most pronounced in the patients who had the least func tional impairment (TLC >75 percent pred) preoperatively. No correlatio n was found between the changes in the pulmonary function test results at follow-up and follow-up interval, preoperative delta LVI, and the change in delta LVI at follow-up.