Pulmonary Function Before Surgery for Pectus Excavatum and at Long-term Follow-up: Treatment

The preoperative mean LVI was 0.36 ±0.11 (predicted, 0.18 ±0.03; p=0.0001) and when corrected for age (5LVI), 7.33 ±4.66 (predicted, 0±1; p<0.0001), which reflected a significantly shorter anteroposterior distance between the vertebral body and sternum. At long-term follow-up, the 5LVI was significantly decreased (—3.30 ± 4.92; p<0.0001): the lower anteroposterior diameter was significantly increased, but was still significantly different from the predicted value (p<0.0001).
Pulmonary function measurements are shown in Tables 2 and 3. The TLC and IVC were reduced in comparison with the normal values for a particular age (p-0.0001). During follow-up, the TLC increased due to normal growth, but as a percentage of predicted, it decreased further from 83.7 ± 12.3 percent to 73.8 ± 12.1 percent (p=0.0001). The IVC increased but as a percentage of predicted also decreased from 78.3 ± 13.5 percent to 70.7 ± 13.6 percent (p=0.0001) Here buy allegra online. The R V as a percentage of predicted preoperatively was not significantly different from the normal values, but decreased during follow-up (p=0.0001). The RV as a ratio of the TLC, however, was significantly higher than predicted (p=0.0001) and decreased during follow-up (p=0.0023). The FRC was reduced compared with the normal values (p=0.0014) and decreased at follow-up from 95.6 ± 24.6 percent to 79.4 ± 16.8 percent (p=0.0001). The lung function parameters that indicate restriction actually deteriorated during follow-up. The preoperative FEVi was reduced compared with the normal values for a particular age (p=0.0001). This was a consequence of the low IVC. When the FEVi was calculated as a fraction of the IVC, the ratio FEVi/IVC was found to be normal. Consequently, there was no significant airway obstruction in this group. At follow-up, the FEVi increased in absolute terms, but decreased when expressed as a percentage of predicted (p=0.0001). The FEVi as a ratio of the vital capacity did not changg significantly during follow-up.
We did not find a statistically significant relation between age and most of the preoperative lung function test results (percent predicted) (Fig 2). The correlation coefficient for the preoperative pulmonary function tests as a percentage of predicted with age was below 0.02, with p values that varied from 0.482 to 0.970.

Table 2—Preoperative Pulmonary Function Tests

Measurement No. of Patients PreoperativeValue p Value Difference With Predicted Value t
TLC, L, % predicted 115 4.848 ±1.713 0.0001
83.7 ±12.3
IVC, L, % predicted 105 3.383 ±1.316 0.0001
78.3 ±13.5
RV, L, % predicted 113 1.332 ±0.541 0.4270
104.6 ±29.5
RV/TLC ratio, % predicted 110 28.1 ±6.3 0.0001
116.5 ±23.8
FRC, L, % predicted 113 2.303 ±0.887 0.0014
79.3 ±14.7
FEVi, L, % predicted 147 2.764± 1.110 0.0001
79.3 ±14.7
FEVi/IVC ratio, % predicted 147 82.5 ±8.2 0.0038
102.1 ±10.1

Table 3—Changes in Pulmonary Function Tests Measured at Follow-up

No. of Patients Follow-up, % Predicted ML %6t % Predicted p Valuef
TLC 113 73.8 ±12.1 +0.21 ±0.87 —11 ± 10 0.0001
IVC 103 70.7 ±13.6 +0.037 ±0.83 -8 ±10 0.0001
RV 111 83.5 ±20.1 +0.01 ±0.38 -23 ±27 0.0001
RV/TLC 111 27.4 ±5.8 +6 ±21 0.0023
FRC 111 79.4 ±16.8 +0.19 ±0.53 —17 ± 19 0.0001
FEVi 145 73.3 ±15.6 +0.39 ±0.77 -6 ±15 0.0001
FEVi/IVC 143 101.2 ±8.8 -1±10 0.1020

Figure-2

Figure 2. Preoperative pulmonary function as a percentage of predicted related to the age at operation. Age group 1,0 to 9 years; group 2,9 to 13 years; group 3,13 to 15 years; group 4,15 to 17 years; group 5, 17 to 20 years; and group 6, >20 years. Only the difference in the ratio measured RV/predicted RV between age groups 1 and 2, 1 and 3, and 4 and 5 reached significance (p values 0.0077, 0.0058, and 0.0419, respectively).

This entry was posted in Pulmonary Function and tagged anteroposterior, cardiorespiratory, lung volumes, pulmonary function.