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J Thorac Cardiovasc Surg 2007;134:1279-1283
© 2007 The American Association for Thoracic Surgery

General Thoracic Surgery

Quantitative evaluation of bone and cartilage changes after the Ravitch thoracoplasty by multislice computed tomography with 3-dimensional reconstruction

^a Department of Pediatric Surgery, Chang Gung Children’s Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
^b Department of Radiology, Chang Gung Children’s Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.

Received for publication December 10, 2006; revisions received April 29, 2007; accepted for publication May 11, 2007.

^_* Address for reprints: Chao-Jan Wang, MD, Department of Radiology, Chang Gung Children’s Hospital, 5, Fu-Hsing St., Kweishan, Taoyuan 333, Taiwan. (Email: cjwang{at}adm.cgmh.org.tw).

Objective: Various bone and cartilage changes after the Ravitch thoracoplasty have recently been reported. In this study, quantitative measurements of long-term changes in the bone, cartilage, and contour of the chest wall through the use of multislice computed tomography with 3-dimensional reconstruction are presented.

Methods: Between 1985 and 2002, 114 patients with pectus excavatum received the Ravitch thoracoplasty in our hospital. Multislice computed tomography with 3-dimensional reconstruction was undertaken in 36 patients 4 to 18 years after the initial operation. Twenty-four patients with pectus excavatum without a surgical intervention were enrolled as a control group. The voxel size of calcification/ossification in regenerated cartilage, costal cartilage shortening ratio, and clubbing index were calculated to quantify the long-term bone and cartilage changes.

Results: The calcification/ossification volume was measured as 5.29 ± 6.94 cm³, which was significantly correlated with the patient’s age at the time of the operation (P = .001). The costal cartilage shortening ratio showed significant shortening of the regenerated cartilage in the third to sixth ribs bilaterally (P < 0.05), and the clubbing index confirmed significant clubbing in the bony ends of the third to fifth ribs (P < 0.05). These changes were not demonstrated in the control group.

Conclusions: After undergoing the Ravitch thoracoplasty, patients sustained significant bone and cartilage changes. The use of multislice computed tomography with 3-dimensional reconstruction may offer both images and quantitative measurements of these changes, but further investigation is necessary to elucidate the clinical impact of these phenomena.