title: Patency of the internal mammary arteries after removal of the Nuss bar: an initial report.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  In 4 (67%) patients, IMA patency was affected unilaterally (total obstruction or highly decreased flow pattern) corresponding with the lowest retrosternal side.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Kemal
authors.initials: K
authors.lastname: Külcü
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Ted W
authors.initials: TW
authors.lastname: Elenbaas
authors.affiliation: Department of Plastic Surgery, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Duy Thuan
authors.initials: DT
authors.lastname: Nguyen
authors.affiliation: Department of Radiology, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Rianne P M
authors.initials: RP
authors.lastname: Verhees
authors.affiliation: Department of Radiology, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Casper
authors.initials: C
authors.lastname: Mihl
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Niels Y
authors.initials: NY
authors.lastname: Verberkmoes
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands.
authors.forename: Albert H M
authors.initials: AH
authors.lastname: van Straten
authors.affiliation: Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands aasmsn@cze.nl.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Soliman Hamad
mesh_terms: D000293:Adolescent; D000328:Adult; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D003251:Constriction, Pathologic; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D061330:Multidetector Computed Tomography; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult
keywords: Computed tomography angiography; Internal mammary artery; Pectus excavatum