Role of preoperative echocardiography in 639 pectus excavatum: structural and functional cardiac alterations in a...

Pectus excavatum (PE) can mechanically displace and compress the heart, often altering right ventricular (RV) geometry and function. Comprehensive preoperative echocardiographic characterization in large adult cohorts is limited. This study describes structural and functional cardiac findings in a large cohort of adults with PE evaluated by transthoracic echocardiography (TTE) prior to surgical repair.

We retrospectively reviewed adult patients undergoing primary minimally invasive repair of PE (MIRPE) at a single tertiary center between January 2016 and July 2024 who had at least one preoperative TTE. Echocardiographic measurements followed scientific guidelines and included anatomical, functional, and hemodynamic assessment of the cardiac chambers, evaluation of valvular morphology, and visual assessment of cardiac compression. Among 639 adults (median age 28 years), cardiac compression was identified in 64% of cases on preoperative TTE. An additional 21% (increased to 85%) had compression subsequently seen on intraoperative echocardiography. Despite preserved conventional systolic parameters such as tricuspid annular plane systolic excursion, a high prevalence of RV functional abnormalities was observed, including reduced tissue Doppler S' velocity in 61.9%, reduced RV fractional area change in 62.4%, impaired RV free-wall longitudinal strain in 70.6%, and reduced RV stroke volume index in 54.7% of patients. Septal motion abnormalities were present in 24%. Mitral valve morphological abnormalities were frequent, with elongated anterior mitral valve leaflets observed in 76.9% of patients and mitral valve prolapse or bowing in 24%.

In this large adult PE cohort, cardiac compression, subclinical RV systolic dysfunction, reduced stroke volume, and mitral valve morphological abnormalities were common, often despite preserved conventional echocardiographic parameters. These findings highlight the importance of a standardized and comprehensive echocardiographic evaluation to detect clinically relevant cardiac involvement in PE.