DYNAMICS OF ELECTROPHYSIOLOGICAL PARAMETERS AND INTRACARDIAC HEMODYNAMICS IN CHILDREN AND ADOLESCENTS BEFORE AND AFTER THORACOPLASTY FOR PECTUS CARINATUM

Introduction. Pectus carinatum (PC) is a common pathology with a tendency to actively progress during adolescence, frequently associated with cardiorespiratory symptoms. However, objective instrumental assessment of the cardiovascular system in PC and the investigation of the effect of thoracoplasty on cardiac functional status remain insufficiently studied. Of particular importance is the assessment of hemodynamics and cardiac electrical activity, taking into account the age-related dynamics of patients.

Objective of the study:To evaluate the dynamics of electrophysiological parameters and intracardiac hemodynamics in patients with pectus carinatum before and after thoracoplasty in a comparative age aspect.

Material and Methods. Children and adolescents admitted for elective surgical treatment of PC via open thoracoplasty were examined. For comparative analysis, patients were divided into two age groups: younger (7–11 years) and older (12–16 years). Central hemodynamics and myocardial electrophysiological characteristics were evaluated in the pre- and postoperative periods using standard 12-lead ECG and echocardiography (EchoCG).

Results. Preoperative data revealed a characteristic feature — a high prevalence of intraventricular block (mainly right bundle branch block), accounting for 61.1% in the 7–11 age group and 46.2% in the 12–16 age group. Hemodynamically, adolescents (12–16 years) initially exhibited hyperdynamic syndrome with signs of early diastolic dysfunction, whereas children aged 7–11 presented with a normodynamic profile accompanied by manifestations of myocardial dystonia. In all patients, statistically significant improvement in ECG parameters was observed postoperatively: QRS duration and intrinsicoid deflection time significantly decreased (p < 0.05–0.01). Surgical treatment contributed to the resolution of hyperdynamics in older children, whereas the younger group exhibited a temporary increase in cardiac output — a compensatory myocardial response to changes in thoracic volume.

Conclusions. Thoracoplasty for pectus carinatum directly affects the cardiovascular system, contributing to improved intraventricular conduction and normalization of intracardiac hemodynamics, the pattern of recovery of which directly depends on the patient's age.