Exertional dyspnoea in patients with pectus excavatum

Most patients with pectus excavatum report better exercise tolerance and less exertional dyspnoea following surgical repair of their chest wall deformity. The reason(s) for this symptomatic improvement remain speculative but include a reversal of deconditioning and improved stroke volume. Improved function or efficiency of the respiratory muscle pump has never been assessed as a potential reason for reduced dyspnoea. An emerging approach to assessing ventilatory constraint during exercise is to plot the tidal flow-volume loops obtained during exercise within the maximal volitional flow-volume envelope obtained at rest. This paper summarises a review of pulmonary function in patients with pectus excavatum before and after surgery, and then illustrates how this newer technique can be applied in order to determine the ventilatory limitation to exercise in this population.