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Published on: April 8, 2013
Cardiac and arterial elastance and myocardial wall stress in children with pectus excavatum
Esra Akyüz Özkan1, Hashem E Khosrashahi2, Halil İbrahim Serin3
1Department of Pediatrics, Bozok University Medical Faculty, Yozgat, Turkey uzdresra@gmail.com.
Insights
Children with pectus excavatum (PE) show reduced myocardial contractility and altered afterload. Echocardiography revealed lower midwall shortening fraction and myocardial fiber stress in PE patients compared to controls.
Area of Science:
- Pediatric Cardiology
- Thoracic Surgery
- Biomedical Engineering
Background:
- Pectus excavatum (PE) is a common congenital chest wall deformity in children.
- PE can impact cardiopulmonary function, necessitating evaluation of cardiac performance.
Purpose of the Study:
- To assess cardiac function in children diagnosed with pectus excavatum.
- To evaluate specific left ventricular (LV) mechanical parameters in relation to PE severity.
Main Methods:
- Echocardiography was performed on 32 children with PE and 40 healthy controls.
- Key parameters assessed included LV wall stress, elastance, midwall shortening fraction, and myocardial fiber stress.
- Haller index (HI) was calculated via CT to quantify PE severity.
Main Results:
- Children with PE exhibited significantly lower midwall shortening fraction (SFmid), LV circumferential end-systolic wall stress (ESWSc), predicted midwall fiber shortening (midwall VCFc), and myocardial fiber stress (MFS) compared to controls.
- These parameters were reduced by 14.9% (SFmid), 27.5% (ESWSc), 20.3% (midwall VCFc), and 20.3% (MFS).
- No significant correlation was found between cardiac parameters and the Haller index in PE patients.
Conclusions:
- Myocardial contractility and afterload are demonstrably affected in children with pectus excavatum.
- These findings highlight the subclinical cardiac impact of PE, even without a correlation to deformity severity.
Objectives:
Pectus excavatum (PE) is one of the most common skeletal deformities of childhood. The study was undertaken to assess cardiac functions in children with PE.
Methods:
Echocardiography was performed on 32 children with PE and 40 age-matched healthy controls. The following parameters were monitored: meridional left ventricular (LV) wall stress (WSM), arterial elastance (Ea), LV elastance at end-systole derived by single beat (Ees(sb)), LV circumferential end-systolic wall stress (ESWSc), midwall shortening fraction (SFmid), predicted midwall fiber shortening for a measured fiber stress (midwall VCFc), myocardial fiber stress (MFS), LV end-systolic dimension (LVES), LV end-diastolic dimension (LVED) and end-systolic blood pressure (Pes), LV wall thickness at end-systole (hes). To assess the severity of PE, Haller index (HI) was calculated by computed tomography of the thorax.
Results:
SFmid, ESWSc, midwall VCFc and MFS were lower in PE children than in controls. The degree to which the parameters SFmid, ESWSc, midwall VCFc and MFS were altered in PE children was 14.9, 27.5, 20.3 and 20.3%, respectively. The minimum HI value of children with PE was 2.00, the maximum value was 4.93 and the arithmetic mean was 2.62 ± 0.56. Of the 32 children, 14 (43.75%) demonstrated mild deformity, 15 (46.88%) showed moderate and only 3 (9.37%) had severe deformity. In children with PE, there was no statistically significant correlation between the cardiac data (ESWSc, midwall VCFc, MFS, Ea, Ees(sb), LVES, LVED, Pes, hes) and HI.
Conclusion:
We found ESWSc, MFS, midwall VCFc and SFmid to be lower in children with PE than in controls. We concluded that the myocardial contractility and afterload is affected in children with PE.
