Evaluation of the internal thoracic artery blood flow before and after Nuss operation: is it reversible?

Abstract

Objective: Obstruction of the internal thoracic arteries (ITAs) by the Nuss bars in minimally invasive repair of pectus excavatum (MIRPE) has been documented in the literature. In this study, we aim to investigate the patency of ITAs before and after repair of the pectus excavatum with the Nuss procedure, by using color Doppler ultrasonography (US). Materials and Methods: Nineteen patients who underwent Nuss procedure were included in this study prospectively. Color Doppler US examinations were performed for comparing ITA patency after insertion of the Nuss bars and after their removal. Patients were evaluated according to gender, age, symmetry of deformity, Haller index, and the number of Nuss bars inserted. Results: Nineteen patients operated with MIRPE (17 male and 2 females with a mean age 21.78±6.35) were enrolled in the study. Eight patients (42.1%) with normal ITA blood flow preoperatively had normal blood flow after removal of the bar. In preoperative examination, 6 patients had bilateral (n=2) or unilateral (n=4) obstruction of the ITA and 5 patients had bilateral (n=2) or unilateral (n=3) abnormally disturbed flow. After the bar removal only 2 (10%) of the affected patients (57.9 %) still had obstruction whereas patent blood flow of the ITAs has been noted in 9 patients. Conclusion: We have shown that after the Nuss bar removal, only 10% of the ITAs are compromised