CC-BY 4.0 · European J Pediatr Surg Rep 2018; 06(01): e18-e22
DOI: 10.1055/s-0038-1623537
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Nuss Procedure for a Patient with Negative Haller Index

Mariela Dore
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Paloma Triana Junco
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Carlos De La Torre
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Alejandra Vilanova-Sánchez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Monserrat Bret
Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Gaspar Gonzalez
Department of Pediatric Traumatology, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Vanesa Nuñez Cerezo
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Javier Jimenez Gomez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Jose Luis Encinas
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Francisco Hernandez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Leopoldo Martínez Martínez
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
,
Manuel Lopez Santamaria
Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Madrid, Spain
› Author Affiliations
Further Information

Publication History

18 April 2017

14 December 2017

Publication Date:
20 February 2018 (online)

Abstract

Introduction Minimally invasive repair for pectus excavatum (MIRPE) is controversial in extremely severe cases of pectus excavatum (PE) and an open repair is usually favored. Our aim is to describe a case of a patient with an extremely severe PE that underwent a minimally invasive approach.

Case report An 8-year-old girl with severe sternum depression was assessed. She had a history of exercise intolerance, nocturnal dyspnea, fatigue, and shortness of breath. Chest computed tomography showed that sternum depression was posterior to the anterior vertebral column; therefore, Haller and correction index could not be measured. Spirometry indicated an obstructive ventilation pattern (forced expiratory volume in 1 second = 74.4%), and echocardiogram revealed a dilated inferior vena cava, mitral valve prolapse with normal ventricular function. After multidisciplinary committee evaluation, a MIRPE approach was performed.

All symptoms had disappeared at the 3-month postoperative follow-up; the desired sternum shape was achieved and normalization of cardiopulmonary function was observed. The Nuss bars were removed after a 2-year period. After 18-month follow-up, the patient can carry out normal exercise and is content with the cosmetic result.

Conclusion Nuss procedure is feasible in our 8-year-old patient. In this case, both the Haller and correction index were not useful to assess the severity of PE. Therefore, under these circumstances, other radiologic parameters have to be taken into consideration for patient evaluation.