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Cardiac morphologic changes after the Nuss operation for correction of pectus excavatum
Jin Yong Jeong1, Hyung Joo Park2, Jongho Lee3
1Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
Insights
Surgical correction of pectus excavatum using the Nuss operation repositions the heart, increasing its dimensions. These morphologic changes suggest the heart returns to a more normal position and shape, potentially improving cardiac function.
Area of Science:
- Cardiothoracic surgery
- Pediatric cardiology
- Thoracic surgery
Background:
- Pectus excavatum can compress the heart, potentially impairing cardiac function.
- Echocardiography suggests surgical correction improves cardiac function.
- Morphologic evidence supporting functional improvement has been lacking.
Purpose of the Study:
- To investigate the morphologic changes of the heart after surgical correction of pectus excavatum.
- To quantify changes in heart position and dimensions following the Nuss procedure.
Main Methods:
- 109 patients underwent the Nuss operation between July and December 2011.
- Measured Haller index, heart position relative to the spine, and heart dimensions.
- Utilized computed tomography measurements for morphologic analysis.
Main Results:
- Postoperative Haller index significantly improved (p<0.001).
- Heart demonstrated anterior and rightward displacement (p<0.01, p=0.027).
- Significant increases in anteroposterior and right oblique heart dimensions were observed (p<0.01).
Conclusions:
- The Nuss operation repositions the heart anteriorly and rightward.
- Surgical correction increases heart dimensions, particularly anteroposterior and right oblique lengths.
- These morphologic shifts suggest a return to a more normalized cardiac position and shape, likely contributing to improved function.
Background:
Pectus excavatum results in compression of the heart and may compromise cardiac function. Several studies have shown that surgical correction improves cardiac function as assessed on echocardiography. However, morphologic changes to support this have not been reported.
Methods:
Between July and December 2011, 109 patients underwent the Nuss operation. We measured the Haller index and other variables. To identify the location of the heart within the chest cavity, the distances from the middle of the spine to the right and left heart walls and from the anterior border of the spine to the anterior and posterior heart walls were measured. To characterize dimensional changes, the anteroposterior, transverse lateral, and right and left oblique longest lengths were measured.
Results:
The postoperative Haller index was significantly different from the preoperative one (2.52±0.40 versus 4.50±1.45; p<0.001). The location changes in the anterior, rightward, and leftward directions were 4.97±8.03 mm (p<0.01), 1.66±7.89 mm (p=0.027), and -2.70±11.12 mm (p=0.01), respectively. The dimensional changes in anteroposterior and right oblique lengths were 5.42±6.42 mm and 16.33±7.77 mm (p<0.01), respectively.
Conclusions:
The heart moved positively in the anterior and rightward directions and negatively in the leftward direction, and the anteroposterior and right oblique dimensions were increased after surgical correction. These data suggest that the heart tends to return to a normal position and shape, and that these changes may contribute to improvement in cardiac function.
