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. 2024 Dec 31;16(12):8565-8581.
doi: 10.21037/jtd-24-1325. Epub 2024 Dec 27.

Phoenix Comprehensive Assessment of Pectus Excavatum Symptoms (PCAPES)

Dawn E Jaroszewski  1 , Mohamed R Aly  1 , Kenan A Shawwaf  1 , J Asher Jenkins  1 , Ryan Moosavi  1 , Rawan M Zeineddine  1 , Ahmed E Khedr  1 , Beth Sandstrom  1 , Chona Cortez  1 , Juan M Farina  1
Affiliations

Phoenix Comprehensive Assessment of Pectus Excavatum Symptoms (PCAPES)

Dawn E Jaroszewski et al. J Thorac Dis. .

Abstract

Background: Pectus excavatum (PE) can cause cardiopulmonary compression with a wide range of symptoms and psychosocial effects. Few validated surveys assess the extensive symptomatology of the adult pectus population. A comprehensive symptom survey was developed and validated with outcomes presented.

Methods: An observational and validation study of a novel symptom survey [Phoenix Comprehensive Assessment of Pectus Excavatum Symptoms (PCAPES)] was performed that included patients evaluated for PE from October 2020-September 2021 at Mayo Clinic Arizona. Survey validation was performed in three phases.

Results: After survey validation, 432 patients completed the PCAPES survey: median age was 30 years [interquartile range (IQR), 23.0, 39.9 years], 57.8% males, median Haller index: 4.2 (IQR, 3.6, 5.4). Common neurological complaints included headaches (74%) and positional dizziness (67%). Regarding cardiovascular symptoms, 6/7 exercise related questions had at least 70% of patients reporting limitations or inability to perform. Pulmonary-wise, >80% noted restricted breathing both with normal activity and during exercise. For gastrointestinal symptoms, nearly half reported some degree of dysphagia with 52% noting post-prandial dyspnea. Psychosocially, patients reported either avoiding activities where their chest could be visible (68%) or feeling bothered by the overall appearance of their chest (80%). Commonly reported complaints were feelings of depression and anxiety (65% each). Females and older patients (≥30) were more severely affected with cardiac symptoms (P<0.05 for all comparisons). Despite being more symptomatic, females were more likely to feel dismissed by their physicians.

Conclusions: Pectus causes a variety of symptoms, and a comprehensive survey should be performed for assessment and indication of further testing.

Keywords: Chest wall; Haller index; patient-reported outcome measurement; pectus excavatum (PE); survey.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-1325/coif). D.E.J. serves as an unpaid editorial board member of Journal of Thoracic Disease from February 2023 to January 2025. D.E.J. reports that she is a consultant with IP/royalty rights under Mayo Clinic Ventures with Zimmer Biomet, Inc. and speaker for Atricure, Inc. and no support of the manuscript was provided by the entities listed; Zimmer Biomet does manufacture the Nuss Implants used at Mayo Clinic Arizona for repair of pectus excavatum, and Atricure, Inc. manufactures the cryoablation device used for cryoablation of intercostal nerves. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Phases performed to conduct this study. PCAPES, Phoenix Comprehensive Assessment of Pectus Excavatum Symptoms; NQ-mA, modified Nuss questionnaire; SF-20, 20-Item Short Form Survey; CT, computed tomography; PFT, pulmonary function test; CPET, cardiopulmonary exercise testing; ARS, autonomic reflex screening.
Figure 2
Figure 2
Results of neurological section of questionnaire.
Figure 3
Figure 3
Results of exercise-related (A) and symptoms-related (B) cardiovascular sections of questionnaire.
Figure 4
Figure 4
Results of pulmonary section of questionnaire.
Figure 5
Figure 5
Results of gastrointestinal section of questionnaire.
Figure 6
Figure 6
Results of psychosocial section of questionnaire.
Figure 7
Figure 7
Age (A) and sex (B) analysis for exercise-related cardiovascular questions.
Figure 8
Figure 8
Age (A) and sex (B) analysis for select cardiovascular symptom questions. P<0.001 for all comparisons in (B).
Figure 9
Figure 9
Age (A) and sex (B) analysis for psychosocial questions.
See this image and copyright information in PMC

References

    1. Coln E, Carrasco J, Coln D. Demonstrating relief of cardiac compression with the Nuss minimally invasive repair for pectus excavatum. J Pediatr Surg 2006;41:683-6; discussion 683-6. 10.1016/j.jpedsurg.2005.12.009 - DOI - PubMed
    1. Jaroszewski DE, Warsame TA, Chandrasekaran K, et al. Right ventricular compression observed in echocardiography from pectus excavatum deformity. J Cardiovasc Ultrasound 2011;19:192-5. 10.4250/jcu.2011.19.4.192 - DOI - PMC - PubMed
    1. Farina JM, Jaroszewski DE, Arsanjani R, et al. Improved Right Ventricular Diastolic Function Assessed by Hepatic Vein Flow After Pectus Excavatum Repair. Annals of Thoracic Surgery Short Reports 2023;1:226-30. 10.1016/j.atssr.2023.02.009 - DOI - PMC - PubMed
    1. Jaroszewski DE, Farina JM, Gotway MB, et al. Cardiopulmonary Outcomes After the Nuss Procedure in Pectus Excavatum. J Am Heart Assoc 2022;11:e022149. 10.1161/JAHA.121.022149 - DOI - PMC - PubMed
    1. Chao CJ, Jaroszewski D, Gotway M, et al. Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain. Ann Thorac Surg 2018;105:294-301. 10.1016/j.athoracsur.2017.08.017 - DOI - PubMed

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