Author + information
- Candice Y. Li,
- Michael Taylor,
- Victor Garcia,
- Rebeccah Brown and
- Mantosh Rattan
Background: Pectus excavatum is the most common chest wall deformity. Pectus can cause extrinsic compression on the heart, interfering with ventricular filling and systolic function. Cardiac magnetic resonance imaging (CMR) allows simultaneous evaluation of the chest wall deformity and quantification of right (RV) and left ventricular (LV) volumes and function. We retrospectively reviewed CMR studies from a large cohort of pediatric patients undergoing evaluation for pectus to determine the relationship between pectus severity, cardiac compression, and cardiac dysfunction.
Methods: Pectus indices [Haller index (HI), correction index, asymmetry index, and depression index] and cardiac compression indices (cardiac compression index and cardiac asymmetry index) were measured using a standardized axial image from clinical CMRs done at our institution from 2012-2015 (n=220; mean age 14.5 years, range 6.0-20.8). RV and LV volumes and ejection fractions (EF), stroke volume, and cardiac index were also measured. Clinical data were obtained by chart review.
Results: 93% of patients had HI>3.25 (mean 6.0±3.8). 80% were symptomatic; 20% had moderate-severe symptoms. 73% underwent pectus repair. 95% had RV compression (60% at RV free wall, 3% at the atrioventricular groove, and 32% at both sites); 49% had moderate-severe RV compression. 19% had decreased RV systolic function with RV EF<50% (range 41-74%). Patients with HI>3.25 had slightly lower RV EF (54±6 vs 56±5, p=0.04). There was no difference in pectus indices or compression indices associated with RV dysfunction. There was no difference in cardiac function or volumes in patients with RV compression regardless of site of compression. RV dysfunction and RV compression were not associated with higher incidence or severity of symptoms.
Conclusions: Some degree of RV compression is seen most pectus patients. Also a substantial number of pectus patients demonstrate RV systolic dysfunction. There is no clear association between RV compression and RV systolic dysfunction. The clinical significance of the RV compression and RV systolic dysfunction are unclear, as both are generally mild with no associated increased symptomatology.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Non Invasive Imaging: MR Scar and Perfusion
Abstract Category: 29. Non Invasive Imaging: MR
Presentation Number: 1244-206
- 2017 American College of Cardiology Foundation