THE EFFECT OF RIGHT VENTRICULAR COMPRESSION ON CARDIAC FUNCTION IN PEDIATRIC PECTUS EXCAVATUM PATIENTS

Background Pectus excavatum can cause right ventricular (RV) dysfunction due to extrinsic compression. Assessment of ventricular function by echocardiography is often suboptimal due to technical limitations. We utilized cardiac magnetic resonance imaging (CMR) to assess pectus severity and RV systolic function in relation to the site of RV compression in a large pediatric pectus cohort. Methods All CMR studies performed for clinical evaluation of pediatric pectus excavatum at our institution were retrospectively reviewed. CMR analysis included evaluation of Haller index, left ventricular (LV) and RV ejection fractions (EF), and indexed LV and RV end-diastolic and end-systolic volumes. The site of maximal compression of the right ventricle (no compression, atrioventricular (AV) groove, or free wall) was assessed. The relationships of age, BSA, Haller index, and ln(Haller) to LVEF, RVEF, and indexed RV end-diastolic volume were assessed using linear regression. The relationships of patient gender and RV compression site to LVEF, RVEF, and indexed RV end-diastolic volume were evaluated using ANOVA with post-hoc Tukey comparisons. Results We analyzed CMR studies from 197 patients with pectus excavatum (163 males, 34 females, age 2.67-24.9 yrs). 28 patients (14.2%) had RVEF<50%. 75 patients had no RV compression, 104 had compression of the RV free wall, and 18 had compression of the AV groove. The Haller index, ln(Haller), and age did not show linear relationships to LVEF, RVEF, or indexed RV end-diastolic volume. The LVEF was significantly lower in patients