Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain

Abstract

Background: The cardiopulmonary benefits of pectus excavatum repair have been debated. Echocardiographic speckle-tracking strain and strain rate have been used to evaluate and detect subclinical myocardial dysfunction in patients receiving cardiotoxic chemotherapy, and patients with valvular heart disease. This technology was applied to evaluate the effects of pectus excavatum surgery on left ventricular (LV) and right ventricular (RV) function.

Methods: Speckle tracing strain evaluation was performed on intraoperative transesophageal echocardiographic images acquired immediately before and after Nuss repair in adult patients (aged 18 years or more) from 2011 to 2014. Standard severity and compression indices were measured on chest imaging performed before pectus excavatum repair.

Results: In total, 165 patients with transesophageal echocardiographic images during repair were reviewed (71.5% male; mean age 33.0 years; range, 18 to 71; Haller index 5.7; range, 2.3 to 24.3). Significant improvement after repair was seen in global RV longitudinal strain (-13.5% ± 4.1% to -16.7% ± 4.4%, p < 0.0001) and strain rate (-1.3 ± 0.4 s^-1 to -1.4 ± 0.4 s^-1, p = 0.0102); LV global circumferential strain (-18.7% ± 5.7% to -23.5% ± 5.8%, p < 0.0001) and strain rate (-1.5 ± 0.5 s^-1 to -1.9 ± 0.8 s^-1, p = 0.0003); and LV radial strain (24.1% ± 13.5% to 31.1% ± 16.4%, p = 0.0050). There was a strong correlation between preoperative right atrial compression on transesophageal echocardiogram and improvement in RV global longitudinal strain rate immediately after pectus repair.

Conclusions: Mechanical compression and impaired RV and LV strain is improved by Nuss surgical repair of pectus deformity.