[Spontaneous evolution of pectus excavatum deformity in children: a five-year prospective study]

The pathophysiologic effects of pectus excavatum (PE) are controversial. Impaired respiratory performance during exercise is minimal and several studies evaluating cardiovascular function have shown conflicting results. There is no evidence that impaired cardiopulmonary performance, if any, is improved by surgical correction of the deformity. Spontaneous improvement or even disappearance of the deformity have been observed, but not extensively studied.

The aim of the present study was to evaluate the spontaneous evolution of PE during the growth period (age 11 to 15 years), as well as the aesthetic component of the deformity based upon the judgment of the subjects, in connection with the evolution of PE and its depth.

A prospective study included 52 boys who were followed-up on a yearly basis (the first examination at the age of 11, the last at the age of 15 years). Two sagittal diameters of the chest were measured: the first at the deepest point of PE, the second over the flexible metal ruler in order to determine the hypothetic chest diameter without depresion. Index of the deformity was calculated by dividing the diameters and multiplying the result by 100. All results are expressed as mean +/- SD. Comparison of initial and follow-up studies for the same individual were compared with the paired t-test.

Statistically significant improvement of the deformity (p<0.05) was observed in 35 subjects and differences between yearly measurements were not significant. In 17 boys the depression deteriorated significantly after five years (p<0.02). The differences between yearly measurements were not significant, except between years 12 and 13. At the age of fifteen, 38.5 per cent of children were satisfied with the appearance of the chest and 61.5 per cent were unsatisfied. The self-perception was not correlated to either spontaneous improvement or deterioration, or the depth of depression.

In spite of numerous studies, pathophysiologic effects of PE and postoperative results are still a matter of controversy. The others believe that psychologic problems are the only indication for surgery, but spontaneous evolution of PE and its psychologic effects have not been extensively studied. The present study demonstrated unpredictable evolution of the deformity ant its complex impact on the psychology of children in puberty, the facts to be considered when contemplating surgery.