Improved Right Ventricular Diastolic Function Assessed by Hepatic Vein Flow After Pectus Excavatum Repair

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Medical Imaging

Background:

• The cardiovascular benefits of pectus excavatum (PEx) repair, particularly in adults, remain debated.
• Hepatic vein flow patterns are indicators of right-sided diastolic dysfunction in various cardiovascular conditions.
• Cardiac compression in PEx can impact diastolic function, necessitating evaluation.

Purpose of the Study:

• To evaluate the impact of PEx repair on cardiac diastolic function.
• To assess changes in hepatic vein flow patterns and velocities before and after PEx repair.
• To correlate the degree of cardiac compression with improvements in diastolic function.

Main Methods:

• Retrospective analysis of intraoperative transesophageal echocardiograms.
• Inclusion of adult patients who underwent PEx repair between 2018 and 2021.
• Assessment of hepatic vein flow patterns and velocities pre- and post-operatively.

Main Results:

• 127 adult patients with PEx were included (median age 29).
• PEx repair led to significant improvements in right ventricular stroke volume and diastolic function (P < .001).
• 5.5% of patients with pre-operative constrictive-like physiology normalized post-operatively; 10% showed altered hepatic vein flow patterns.

Conclusions:

• Surgical relief of cardiac compression in PEx patients results in immediate improvements in hepatic vein flow and right ventricle stroke volume.
• These findings support the presence of diastolic dysfunction in many PEx patients, which improves post-repair.
• Enhanced diastolic function and compliance are observed after surgical decompression in PEx.