The maximum heart rate reached during the exercise tests did not differ between the two groups during the 3 years. And much like Rowland et al. we also considered the possible different habitual exercise habits of the patients and the control subjects. However, at no point during the 3 years did we find any significant difference between the groups. The increased exercise function could thereby not be explained by a higher level of physical activity following the corrective surgery.

The Haller Index was also examined by MRI in both groups throughout the 3 years follow-up study and these measurements showed a significant decrease in the indices in the patient group, with no changes seen in the control group. No difference existed between the groups following bar-removal. But in contrast to the study done by Swanson et al. [15], we did not find any correlation between a decreased cardiac exercise function and a high Haller index. In other words, it was not the severity of the chest wall deformity in our study that determined the level of reduced exercise function.

Echocardiographic studies investigating postoperative results both after the Ravitch and also the Nuss Procedure have shown an increased right ventricular end-diastolic diameter, which might be caused by the decreased pressure from the sternum, causing better filling of the right ventricle. However, these studies are only done at rest [16, 17].

With these results it is illustrated that following corrective surgery, the cardiac exercise function of the patients with PE normalizes compared to a healthy, age-matched control group and also increases the cardiac performance in adults. Surgical correction of PE should be considered in all patients who presents with symptoms of reduced physical performance and not only for patients with cosmetic complaints.