Külcü Kemal, Elenbaas Ted W, Nguyen Duy Thuan, Verhees Rianne P M, Mihl Casper, Verberkmoes Niels Y, van Straten Albert H M, Soliman Hamad Mohamed A
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
Department of Plastic Surgery, Catharina Hospital, Eindhoven, Netherlands.
Interact Cardiovasc Thorac Surg. 2014 Jul;19(1):6-9. doi: 10.1093/icvts/ivu083. Epub 2014 Mar 30.
Surgical correction of pectus excavatum (PE) has shifted to the modern minimally invasive Nuss procedure, which proved to be safe and effective. In order to restore the dented deformity, custom-curved metal bars provide continuous retrosternal pressure but cross the habitat of the internal mammary arteries (IMAs) directly affecting their patency. In this initial report, we sought to assess the patency of the IMAs in the first 6 patients who underwent Nuss bar removal in our department.
In 2010, we started to perform correction of PE using the Nuss bar technique. In 2013, observational analysis was performed on the first 6 patients who underwent removal of the Nuss bar. Computed tomography angiography (CTA) was performed in order to assess the patency of both IMAs directly after removal.
In 4 (67%) patients, IMA patency was affected unilaterally (total obstruction or highly decreased flow pattern) corresponding with the lowest retrosternal side.
According to our preliminary results, the oppressive force of Nuss bars interferes with IMA patency and thereby compromises future usability in coronary artery bypass grafting (CABG). We recommend that patients undergoing CABG following the Nuss procedure undergo preoperative evaluation of IMA patency. This study will be continued to include a larger number of patients including follow-up CTA one year after removal of the bar.
漏斗胸（PE）的手术矫正已转向现代微创Nuss手术，该手术已被证明是安全有效的。为了修复凹陷畸形，定制弯曲的金属棒提供持续的胸骨后压力，但会直接穿过胸廓内动脉（IMA）的分布区域，从而直接影响其通畅性。在本初步报告中，我们试图评估在我们科室接受Nuss棒取出术的前6例患者的IMA通畅情况。
2010年，我们开始使用Nuss棒技术进行PE矫正。2013年，对首批6例接受Nuss棒取出术的患者进行了观察分析。在取出Nuss棒后立即进行计算机断层扫描血管造影（CTA），以评估双侧IMA的通畅情况。
在4例（67%）患者中，IMA通畅性受到单侧影响（完全阻塞或血流模式高度降低），与胸骨后最低侧相对应。
根据我们的初步结果，Nuss棒的压迫力会干扰IMA的通畅性，从而影响其在冠状动脉旁路移植术（CABG）中的未来可用性。我们建议，接受Nuss手术后行CABG的患者应在术前评估IMA的通畅情况。本研究将继续纳入更多患者，包括在取出Nuss棒一年后进行随访CTA。
