Changes in thoracic cavity dimensions of pectus excavatum patients following Nuss procedure

Abstract

Background: Using a simple and intuitive method, we evaluated changes in the dimensions of the thoracic cavity of pectus excavatum (PE) patients following the Nuss procedure.

Methods: We performed a retrospective review of 141 patients who had undergone the Nuss procedure. The thoracic cavity was visualized using computed tomography (CT) scans and its dimensions determined by measuring the anteroposterior (AP) and transverse (T) diameters at three anatomical landmarks (the jugular notch, and manubriosternal and xiphisternal joints). The Wilcoxon signed-rank test was used to compare differences between preoperative and postoperative parameters. Kruskal-Wallis tests were performed to compare differences among groups in patient age, type of PE, and number of inserted bars.

Results: Of the 141 patients (115 men, 26 women), 87 had symmetric and 54 had asymmetric defects. The postoperative AP diameters at the manubriosternal and xiphisternal joints were significantly higher than their preoperative values, whereas the Haller indices and T diameters at the three anatomical landmarks were significantly lower than their preoperative values. In the multiple bars group, the postoperative AP diameters increased significantly compared with their preoperative values. In the multiple bars group, and in patients aged above 13 years, the postoperative T diameters at all three anatomical landmarks decreased significantly compared with their preoperative values.

Conclusions: Correction of anterior depression of the sternum and compensatory narrowing of the chest width were observed in PE patients following the Nuss procedure. Further research will be necessary to determine the relationship between these observations and postoperative changes in chest volume.

Keywords: Chest wall; Haller index; Nuss procedure; pectus excavatum (PE); three-dimensional.

Figure 1

The thoracic dimension in three anatomical landmarks. (A) Preoperative AP and T diameter in jugular notch; (B) postoperative AP and T diameter in jugular notch; (C) preoperative AP and T diameter in manubriosternal joint; (D) postoperative AP and T diameter in manubriosternal joint; (E) preoperative AP and T diameter in xiphisternal joint; (F) postoperative AP and T diameter in xiphisternal joint. AP, anteroposterior; T, transverse.

Figure 2

Haller index and the dimensions of thoracic cavity of pectus excavatum patients before and after the Nuss procedure. The Wilcoxon signed-rank test was used to compare each parameter. Statistical significance was defined as P<0.05. (A) Preoperative (PRE) and postoperative (POST) Haller index (HI); (B) preoperative and postoperative anteroposterior diameter in jugular notch (JN_AP); (C) preoperative and postoperative transverse diameter in jugular notch (JN_T); (D) preoperative and postoperative AP diameter in manubriosternal joint (MJ_AP); (E) preoperative and postoperative T diameter in manubriosternal joint (MJ_T); (F) preoperative and postoperative AP diameter in xiphisternal joint (XJ_AP); (G) preoperative and postoperative T diameter in xiphisternal joint (XJ_T).