Demographic characteristics, cardiac and clinical findings of PC, PE patients and healthy group are summarized in Tables 1 and 2. The median age of 82 PE patients, consisted of 16 (20%) girls and 66 (80%) boys, was 10 years. Except for cosmetic concerns, patients were mostly asymptomatic (84%). But less frequently, some patients also complained of chest pain (10%) and exertional dyspnea (6%). 44% of children with PE had a family history of similar chest wall deformity. In addition, three patients with chest deformity had marfanoid phenotype features such as high stature, asthenic body structure, arachnodactyly, characteristic facial features, etc. [15]. Echocardiographic examination revealed MVP in 25% of the patients with PE, and it was observed that MVP was often accompanied by mitral valve leakage. A mitral valve leak was detected in 11% of the patients with PE. 6% of mitral valve leaks were mild and 5% were mild-moderate. As concomitant heart disease, one patient with PE had silent patent ductus arteriosus, one patient had bicuspid aorta, one patient had mild septal hypertrophy, one patient had ventricular septal defect, one patient had aortic root dilatation (Z score ≥ 2). As an additional finding, patent foramen ovale (PFO) was detected in 7% of patients with PE.
Table 1
Demographic characteristics of the study population
Characteristics
|
|
Healthy children
N (%)
|
PE
N (%)
|
PC
N (%)
|
P value
|
Number of children
|
|
107
|
82
|
27
|
|
Age, y
|
Median
|
12
|
10
|
10
|
0.07*/0.06 **
|
|
Distribution
|
|
|
|
|
|
1–5 y
|
0
|
26 (32)
|
6 (22)
|
|
|
6–10 y
|
37 (35)
|
18 (22)
|
9 (33)
|
|
|
11–18 y
|
70 (65)
|
38 (46)
|
12 (45)
|
|
Sex, n (%)
|
Male
|
91 (85)
|
66 (80)
|
22 (81)
|
0.7
|
|
Female
|
16 (15)
|
16 (20)
|
5 (19)
|
|
PE: Pectus excavatum, PC: Pectus Carinatum Available findings were given as median or n (%). N is the number of patients with complete data in the total patients. *Statistical analyses between healthy children and PE, ** between healthy children and PC. |
Table 2
Cardiac and clinical signs of the study population.
Characteristics
|
PE
N (%)
|
PC
N (%)
|
Healthy Group
N (%)
|
P value
|
Clinical Signs
|
|
|
|
Asymptomatic
|
69 (84)
|
26 (96)
|
107(100)
|
|
Chest Pain
|
8 (10)
|
0
|
|
|
Exertional Dyspnea
|
5 (6)
|
1 (4)
|
|
|
Murmur
|
8 (10)
|
0
|
|
|
Family History
Marfanoid Phenotype
|
36 (44)
1 (1)
|
7 (26)
2 (7)
|
|
|
Echocardiography
|
|
|
|
|
MVP
|
21 (25)
|
9 (33)
|
2 (2)
|
< 0.001
|
TVP
|
1 (1)
|
4 (15)
|
0
|
< 0.001
|
Mitral Valve Leak
|
9 (11)
|
8 (30)
|
3 (3)
|
< 0.001
|
Mild
|
5 (6)
|
6 (22)
|
2 (2)
|
|
Mild-moderate
|
4 (5)
|
2 (8)
|
1 (1)
|
|
Moderate-severe
|
0
|
0
|
0
|
|
PFO
|
6 (7)
|
4 (15)
|
5 (5)
|
0.18
|
PDA (Silent)
|
1 (1)
|
0
|
0
|
|
Bicuspid Aorta
|
1 (1)
|
0
|
1(1)
|
|
Hypertrophy
|
1 (1)
|
0
|
0
|
|
VSD
|
1 (1)
|
0
|
0
|
|
PS
|
0
|
0
|
1(1)
|
|
Aortic Root Dilatation
|
1(1)
|
0
|
0
|
|
PE: Pectus excavatum, PC: Pectus Carinatum, MVP: Mitral Valve Prolapse, TVP: Tricuspid Valve Prolapse, PFO: Patent Foramen Ovale, PDA: Patent Ductus Arteriosus, VSD: ventricular septal defect, PS: Pulmonary stenosis Available findings were given as median or n (%). N is the number of patients with complete data in the total patients. |
Twenty-seven PC patients with median age of 10, consisted of 5 (19%) girls and 22 (81%) boys. Almost all PC patients were asymptomatic (96%), except for one patient who complained of exertional dyspnea. 26% of children with PC had a family history of similar chest wall deformity. MVP, mitral valve leakage, and tricuspid valve prolapse were more common in PC patients with a frequency of 33%, 30% and 15%, respectively. 22% of mitral valve leaks were mild, and 8% were mild-moderate. In addition, 15% of PC patients had PFO.
One hundred and seven healthy children with a median age of 12, consisted of 16 (15%) girls and 91 (85%) boys. All healthy children were asymptomatic. MVP, mitral regurgitation, bicuspid aorta, pulmonary stenosis and PFO were detected in frequency of 2%, 3%, 1%, %1, and 5%, respectively in healthy children.
The frequency of both pectus anomalies was four times more in males than in females. Among all pectus patients, the highest number of patients was in the adolescent group. There was a significant difference between the healthy group and the PE group in terms of MVP and Mitral Valve leakage (p < 0.001 and p:0.02). In addition, a significant difference was found between the healthy group and PC group in terms of MVP, TVP, and Mitral Valve leakage (p < 0.001, p:0.001, and p < 0.001, respectively). There was no significant difference between other concomitant heart diseases. In addition, the frequency of MVP increased with age in children with pectus anomaly (r: 0.267, p = 0.005).