Abstract
Purpose
To establish whether new indices on plain chest X-ray (CXR) can replace those on computed tomography (CT) for the follow-up of children who have undergone the Nuss procedure.
Methods
The subjects of this retrospective study were 45 children who underwent the Nuss procedure between 2000 and 2016. The Haller index (HI) was measured by preoperative CT. Preoperative and postoperative chest deformities were evaluated by two CXR measurements: the concave rate on the lateral view (CR; the depth of the concavity divided by the anterior–posterior diameter of the rib cage) and the tracheal bifurcation angle (TBA) on the anterior view. Data are expressed as the median with range.
Results
The median age and HI of the children, when they underwent the Nuss procedure, was 9.3 (3.8–17.3) years and 4.5 (3.2–10.1), respectively. The preoperative CR was correlated significantly with the HI. The postoperative CR was significantly lower than the preoperative CR [pre: 0.17 (0.08–0.37), post: 0.09 (0.01–0.18), p < 0.05], and the low value was sustained after bar removal. The TBA decreased significantly after the Nuss procedure from 74.2° (55–104) preoperatively to 65.0° (45–92) postoperatively (p < 0.05).
Conclusions
These results suggest that CXR can replace CT for the follow-up of patients after the Nuss procedure, with lower radiation exposure.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Nasr A, Fecteau A, Wales PW. Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis. J Pediatr Surg. 2010;45(5):880–6. https://doi.org/10.1016/j.jpedsurg.2010.02.012.
Kanagaratnam A, Phan S, Tchantchaleishvilli V, Phan K. Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(5):409–21. https://doi.org/10.21037/acs.2016.08.06.
Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg. 2016;5(5):422–33. https://doi.org/10.21037/acs.2016.08.05.
Pawlak K, Gasiorowski L, Gabryel P, Galecki B, Zielinski P, Dyszkiewicz W. Early and late results of the Nuss procedure in surgical treatment of pectus excavatum in different age groups. Ann Thorac Surg. 2016;102(5):1711–6. https://doi.org/10.1016/j.athoracsur.2016.04.098.
Alex J, Haller J, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. 1987;2(10):904–6.
Kelly RE, Goretsky MJ, Obermeyer R, Kuhn MA, Redlinger R, Haney TS, et al. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252(6):1072–81. https://doi.org/10.1097/SLA.0b013e3181effdce.
Poston PM, Patel SS, Rajput M, Rossi NO, Ghanamah MS, Davis JE, et al. The correction index: setting the standard for recommending operative repair of pectus excavatum. Ann Thorac Surg. 2014;97(4):1176–9. https://doi.org/10.1016/j.athoracsur.2013.12.050(discussion 9-80).
Chang PY, Chang CH, Lai JY, Chen JC, Perng DB, Zeng Q. A method for the non-invasive assessment of chest wall growth in pectus excavatum patients. Eur J Pediatr Surg. 2010;20(2):82–4. https://doi.org/10.1055/s-0029-1241819.
Gomes-Fonseca J, Vilaca JL, Henriques-Coelho T, Direito-Santos B, Pinho ACM, Fonseca JC, et al. A new methodology for assessment of pectus excavatum correction after bar removal in Nuss procedure: preliminary study. J Pediatr Surg. 2017;52(7):1089–97. https://doi.org/10.1016/j.jpedsurg.2016.12.029.
Lain A, Garcia L, Gine C, Tiffet O, Lopez M. New methods for imaging evaluation of chest wall deformities. Front Pediatr. 2017;5:257. https://doi.org/10.3389/fped.2017.00257.
Lee C, Zavala-Garcia A, Teekappanavar N, Lee C, Idowu O, Kim S. Measurement of sternal curvature angle on patients with pectus excavatum. Pediatr Surg Int. 2017;33(1):65–7. https://doi.org/10.1007/s00383-016-3996-9.
McHugh MA, Poston PM, Rossi NO, Turek JW. Assessment of potential confounders when imaging pectus excavatum with chest radiography alone. J Pediatr Surg. 2016;51(9):1485–9. https://doi.org/10.1016/j.jpedsurg.2016.02.041.
Ohno K, Morotomi Y, Nakahira M, Takeuchi S, Shiokawa C, Moriuchi T, et al. Indications for surgical repair of funnel chest based on indices of chest wall deformity and psychological state. Surg Today. 2003;33(9):662–5. https://doi.org/10.1007/s00595-003-2575-6.
Backer OG, Brunner S, Larsen V. Radiologic evaluation of funnel chest. Acta Radiol. 1961;55(4):249–56. https://doi.org/10.3109/00016926109175118.
Kilda A, Lukoševičius S, Barauskas V, Jankauskaitė Ž, Basevičius A. Radiological changes after Nuss operation for pectus excavatum. Medicina (Kaunas). 2009;45(9):699–705.
Ishimaru T, Kitano Y, Uchida H, Kawashima H, Gotoh C, Satoh K, et al. Growth spurt-related recurrence after Nuss procedure. J Pediatr Surg. 2009;44(8):E13–E1616. https://doi.org/10.1016/j.jpedsurg.2009.04.014.
Tahir N, Ramsden WH, Stringer MD. Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children. Eur J Pediatr. 2009;168(3):289–95. https://doi.org/10.1007/s00431-008-0751-9.
Kamiyama M, Usui N, Tani G, Nose K, Kimura T, Fukuzawa M. Airway deformation in patients demonstrating pectus excavatum with an improvement after the Nuss procedure. Pediatr Surg Int. 2011;27(1):61–6. https://doi.org/10.1007/s00383-010-2709-z.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Matsuura, R., Tazuke, Y., Ueno, T. et al. Can plain chest X-ray replace computed tomography for the follow-up of children who have undergone the Nuss procedure?. Surg Today 50, 1249–1254 (2020). https://doi.org/10.1007/s00595-020-02020-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-020-02020-8