Updated: Jun 21, 2020
People with Pectus often grapple with the healthcare system. Some physicians may give inaccurate advice based on a false belief that a pectus deformity is always cosmetic. Other patients may experience a range of physical or psychosocial symptoms and may see multiple specialists, such as cardiologists, pulmonologists, psychiatrists, and pediatric surgeons.
The wide heterogeneity in the experience of patients with pectus is also due to the lack of standardized guidelines. How should people with pectus be evaluated? What are the appropriate tests to evaluate potential underlying cardiac or pulmonary problems?
These questions usually arise when patients consider surgery. Patients and their providers are faced with determining whether surgery could provide symptomatic benefit. The issue is further complicated by insurance coverage and the frequent need for surgical authorizations.
In a new study presented at the 2020 Annual Meeting for American Pediatric Surgical Association, a team from McGill University and the Shriners Hospital in Montreal evaluated the utility of echocardiography (ultrasound of the heart) and pulmonary function testing in the preoperative management of patients with pectus excavatum.
Although echocardiogram and pulmonary function testing are commonly used in the preoperative workup, it is currently unclear whether these tests are helpful. The researchers, therefore, studied 116 pectus patients who underwent the Nuss procedure from 2004-2018. They looked at patient symptoms, Haller index, and results of echocardiography and pulmonary function tests.
The researchers found that although most patients were symptomatic, symptoms did not correlate with pectus severity and did not predict abnormal results of echocardiography or pulmonary function testing. Echocardiography was useful mostly to inform which patients needed further follow up after surgery.
"This is a practice-changing publication," says senior author Dr. Sherif Emil, MD, a pediatric surgeon at McGill University.
This study and others have challenged the utility of the Haller index as a proxy measure for symptom severity in patients with pectus. The researchers conclude that routine echocardiogram is indicated in people with pectus to screen for cardiac anomalies, which may be present, but that routine pulmonary function testing is not indicated.
Dr. Emil summarizes the findings by saying that "test results do correlate with severity of pectus, but do not influence the decision to operate". The researchers hope that this work will help push insurance companies away from relying on these tests for surgical approval.