Demonstrating relief of cardiac compression with the Nuss minimally invasive repair for pectus excavatum

Abstract

Background/purpose: Anatomic and physiological parameters have not been routinely used in the preoperative and postoperative evaluation of pectus excavatum. Most symptomatic patients have had significant subjective improvement after pectus correction. This study is based upon the use of noninvasive upright echocardiography/electrocardiogram (echo/EKG) with exercise to both identify and provide evidence of correction of cardiac abnormalities resulting from pectus excavatum.

Methods: One hundred twenty-three patients, 99 males and 24 females, ages 5 to 18 years (average, 13 years) underwent Nuss pectus repair. A retrospective review of their medical records was performed.

Results: Symptoms related to exertion were present in 106 (86%). The mean Haller chest wall index (CWI) was 4.3 (2.4-10.85). Preoperative echo/EKG with exercise revealed cardiac compression in 117 (95%). A mitral valve abnormality was present in 54 (44%). Six children had no chamber compression but mitral valve prolapse was present in 2 and significant arrhythmias in 4. All patients were asymptomatic after surgery. Postoperative echo/EKG with exercise was performed in 107 (87%). The postoperative echo/EKG was normal in 100 (93% of those studied). Mild persistent mitral valve prolapse existed in 7. There were no postoperative arrhythmias. Twelve (9.8%) patients with low CWI (<3.25) were relieved of chamber compression and had no postoperative arrhythmia. Patent ductus was discovered in 2 patients on their postoperative echos. One closed spontaneously. A child with Marfan syndrome required interventional occlusion.

Conclusion: Noninvasive echo/EKG with exercise is beneficial in the evaluation of patients with pectus excavatum and provides objective evidence of improvement postoperatively. It is especially valuable as a physiological indicator of cardiac abnormality in patients with a CWI below 3.25. Patients with mitral valve prolapse need long-term follow-up.