Elective pectus bar removal following Nuss procedure for pectus excavatum: a single-institution experience.

OBJECTIVE: Very few data are available on complications following elective bar removal after the Nuss procedure for pectus excavatum. The objective of this study was to investigate the data from 343 consecutive patients. METHODS: From 2003 to 2009, 343 patients (85% males) had their pectus bar removed. Nine patients were excluded because of bar removal within the first year after implantation. Data were recorded from hospital records regarding: operation time, formation of callus around the bar, unilateral or bilateral incision, complications, postoperative hospital stay and if a senior resident or an intern performed the operation. RESULTS: The median age at the time of bar removal was 19.1 years. The median time for removal after insertion of the bar was 1139 days (range 641-2575 days). The median operation time was 34 min (range 5-183 min). The operation time depended on the formation of callus around the bar (p<0.0001), numbers of bars to be removed (p<0.0002), the need for bilateral incision (p<0.0001) and the charge of the surgeon performing the operation (p<0.0008). Eight patients (2.4%) had complications after the surgery. Five patients had pneumothorax, of which three were treated with chest tubes, and two controlled with chest X-ray. Three patients had hemothorax. Two were treated with a chest tube and the third required open surgery. Most of the patients were discharged on the day of surgery (94%) or the day after surgery (4%). Only six (2%) required more than a single day of hospitalization. CONCLUSIONS: Bar removal following the Nuss procedure is a quick and safe operation with very few complications. Occurrence of complications is not dependent on the experience of the surgeon.

The effects of surgically induced right bundle branch block on left ventricular function after closure of the ventricular septal defect.

OBJECTIVE: To determine the long-term significance of right bundle branch block on left ventricular systolic and diastolic function in children subsequent to surgical closure of ventricular septal defect. METHODS: We studied 26 children who underwent surgical closure of a ventricular septal defect 11 +/- 2 years postoperatively by use of conventional and tissue Doppler echocardiography, comparing the findings to those obtained from a control group. Of those having surgical correction 14 had postoperative right bundle branch block. RESULTS: Irrespective of the presence of right bundle branch block, the peak systolic velocity of the mitral ring was lower in those undergoing surgical correction, with values of 5.2 +/- 1.4 cm/s in those with right bundle branch block, 5.4 +/- 1.2 cm/s in those without right bundle branch block after surgical correction, and 6.6 +/- 1.0 cm/s in the control subjects (p < 0.01). In terms of diastolic function, the early septal velocity of transmitral inflow divided by the early diastolic mitral annular velocity was significantly higher in children with right bundle branch block, at 12 +/- 3.0 cm/s compared to 8.4 +/- 1.5 cm/s in the control subjects (p < 0.01), but not significantly higher in the children without right bundle branch block after correction compared to the control group. The fractional shortening percentage was similar in both patients and control subjects. The changes noted in left ventricular function were not significantly related to age at surgery, the period of follow-up, or the surgical method. CONCLUSIONS: Systolic long axis function is significantly reduced in children after surgical closure of ventricular septal defects, irrespective of the presence of right bundle branch block. Diastolic dysfunction, in contrast, was observed primarily in children with post-operative right bundle branch block.