Phd in ANGIO-CARDIO-THORACIC PATHOPHYSIOLOGY AND IMAGING

Thesis title: Trattamento chirurgico delle deformità della parete toracica anteriore nelle collagenopatie: analisi comparativa degli outcome funzionali e morfostrutturali

Introduction: Anterior chest wall deformities, particularly pectus excavatum and pectus carinatum, have historically been regarded as conditions with predominantly cosmetic impact. Increasing evidence, however, demonstrates significant involvement of cardiopulmonary function, especially in patients affected by connective tissue disorders (collagenopathies). Materials and Methods: A three-year case-control study (January 2023–September 2025) was conducted across three referral centers. Sixty adult patients (≥18 years, Haller Index >2) were enrolled and divided into a study group (30 patients with chest wall deformity associated with collagenopathies) and a control group (30 patients with isolated deformities). All patients underwent surgical correction using the mini-Ravitch or Ravitch technique. Pre- and postoperative assessment included cardiopulmonary exercise testing (CPET), whole-body plethysmography, cardiac magnetic resonance imaging (CMR), transthoracic echocardiography, and psychological evaluation. Follow-up CPET and CMR were performed three months after bar removal in patients with pectus excavatum and six months after surgery in patients with pectus carinatum. Statistical analysis was carried out using paired and unpaired t-tests, with significance set at p < 0.05. Results: Operative time, length of hospital stay, and complication rates were comparable between the two groups. One major complication (acute pericarditis) was observed in the collagenopathy group. CPET demonstrated significant improvements in both groups, including increased peak VO₂, anaerobic threshold, maximal workload, and ventilatory efficiency, along with reduced perceived dyspnea (p < 0.005). CMR documented a significant reduction in the sternal torsion angle, associated with improved right and left ventricular ejection fractions. No statistically significant intergroup differences were found in functional or morphostructural outcomes. Hematological parameters remained stable postoperatively. Conclusions: Surgical correction of anterior chest wall deformities results in significant improvement in functional and morphostructural parameters, regardless of the presence of collagenopathies. Connective tissue disorders do not represent a contraindication to corrective surgery; rather, in these patients surgery plays an important role in improving cardiopulmonary function. The integration of dynamic assessments such as CPET and CMR is central to surgical indication, even in mild-to-moderate deformities, challenging the traditional view of these conditions as purely aesthetic. A multidisciplinary approach is essential to optimize patient selection and timing of intervention.