Recurrence of pectus excavatum in long-term follow-up after the Nuss procedure in young children based on the radiographic Haller index
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In brief
In brief
Long-term radiographic follow-up of 42 children who underwent Nuss procedure before age 10 shows progressive increase in Haller index after bar removal, suggesting risk of recurrence during growth. Radiographic measurements demonstrated significant worsening at 3 and 5 years post-removal despite initial correction.
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Abstract
Background/Purpose
To show the changes of the thorax after bar removal in young children with pectus excavatum in long-term postoperative follow-up.
Methods
A total of 173 patients who underwent Nuss procedure under the age of 10 years from January 2005 to December 2013 and underwent bar removal were retrospectively reviewed. Then, Patients who were followed-up for more than 5 years after bar removal were selected and assessed. All patients were evaluated with the Haller index (HI) by chest computed tomography before the Nuss procedure. Follow-up after bar removal was done by two-view radiography. Radiographic HI (rHI) change was evaluated from before bar removal, to immediately after bar removal, and 3 years and 5 years after bar removal.
Results
Forty-two patients (35 boys, 7 girls) were followed-up for more than 5 years after bar removal. The average age at the Nuss procedure was 6.1 ± 1.3 years, and the average HI was 5.07 ± 1.54. The average age at bar removal was 8.5 ± 1.2 years. The average rHI was 2.47 ± 0.33 before bar removal, 2.75 ± 0.50 immediately after bar removal, 3.24 ± 0.64 at 3 years after bar removal, and 3.46 ± 0.91 at 5 years after bar removal. The rHI value increased significantly between all periods.
Conclusions
The Nuss procedure for young children may have the risk of recurrence during growth after bar removal.
Level of Evidence
Level IV.