Cardiac morphologic changes after the Nuss operation for correction of pectus excavatum.

Abstract

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. 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. 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. 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.