Vol.:(0123456789) 1 3 Pediatric Surgery International https://doi.org/10.1007/s00383-020-04738-5 ORIGINAL ARTICLE The chest wall gender divide: females have better cardiopulmonary function and exercise tolerance despite worse deformity in pectus excavatum Alejandra M. Casar Berazaluce 1  · Todd M. Jenkins 1  · Aaron P. Garrison 1  · William D. Hardie 2  · Karla E. Foster 2  · Tarek Alsaied 3  · Justin Tretter 3  · Ryan A. Moore 3  · Robert J. Fleck 4  · Victor F. Garcia 1  · Rebeccah L. Brown 1 Accepted: 1 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Purpose Pectus excavatum (PE) is a chest wall deformity of variable severity and symptomatology. Existing female-specifc literature highlights breast asymmetry and cosmetic reconstruction. We sought to evaluate gender diferences in cardiopul- monary function. Methods Cardiac MRIs, pulmonary function tests (PFTs), and cardiopulmonary exercise tests (CPETs) were reviewed in 345 patients undergoing preoperative evaluation for PE. Regression modeling was used to evaluate associations between gender and clinical endpoints of cardiopulmonary function. Results Mean age was 15.2 years, 19% were female, 98% were white. Pectus indices included median Haller Index (HI) of 4.8, mean depression index (DI) of 0.63, correction index (CI) of 33.6%, and Cardiac Compression Index (CCI) of 2.79. Cardiac assessment revealed decreased right and left ventricular ejection fraction (RVEF, LVEF) in 16% and 22% of patients, respectively. PFTs and CPETs were abnormal in ~ 30% of patients. While females had deeper PE deformities—represented by higher pectus indices—they had superior function with higher RVEF, LVEF Z-scores, FEV 1 , VO 2 max, O 2 pulse, work, and breathing reserve (p < 0.05). Conclusion Despite worse PE deformity and symptomatology, females had a better cardiopulmonary function and exercise tolerance than males. Further research is needed to assess the precise mechanisms of this phenomenon and postoperative outcomes in this population. Keywords Pectus excavatum · Haller index · Cardiac compression index · Cardiac magnetic resonance imaging · Pulmonary function testing · Cardiopulmonary exercise testing Introduction Pectus excavatum (PE) is the most common chest wall deformity. Also known as “funnel chest”, it presents with a central depression of the anterior chest wall with intrusion into the thoracic cavity. With an incidence around 1/400 live births and a nearly 5:1 male to female ratio [1], this condi- tion has been mostly ascribed to males and rarely studied in female cohorts. Gender-specifc academic literature has focused on aes- thetic results [2], breast volume and asymmetry [3], and patient perceptions and techniques for camoufaging of the deformity independent of pectus repair [4]—all issues that ignore the underlying functional impairment in favor of external appearance. * Rebeccah L. Brown rebeccah.brown@cchmc.org 1 Department of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC2023, Cincinnati, OH 45229, USA 2 Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA 3 Division of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA 4 Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA