Chest X-ray imaging after chest tube removal in children undergoing congenital heart surgery: May be life-saving in redo patients

Background/Aim: Parallel to the developments in congenital heart surgery, the number of children undergoing resternotomy (redo) heart surgery is increasing. In this specific group of patients, post-operative pneumothorax (PTX) and atelectasis are preventable respiratory complications. However, in the literature, pediatric data are still limited. In this study, we draw attention to the frequency and importance of PTX, a post-operative respiratory complication in redo patients. We investigate the necessity for routine chest X-rays to detect PTX following chest tube removal after closed or open-heart operations for congenital heart disease. 
Methodsː A total of 554 consecutive pediatric patients who underwent cardiac surgery were analyzed. The study was designed as a retrospective cohort study. The patient’s demographic data, clinical characteristics with chest tube removal, and pathologies detected by chest X-ray were recorded. Patients were divided into non-redo and redo groups or subgroups. Patients who developed PTX (n = 24) were divided into subgroups: asymptomatic or symptomatic and large or small. Data analysis and statistical comparison between the groups were performed with independent-samples t-test or Mann-Whitney U test. 
Resultsː In 24 (4.3%) of the 554 patients included in the study, PTX was detected in the post-operative evaluation after chest tube removal. Of the PTX cases, 15 (62.5%) were small, and nine (37.5%) were large. Ten (41.6%) patients were symptomatic, while nine patients had large PTX, and one patient with small PTX was identified. There were significantly more cases of large PTX in redo cases than in non-redo cases (P = 0.038). PTX was significantly more symptomatic in redo patients than non-redo patients (P = 0.031). 
Conclusionː In patients undergoing cardiac surgery for the first time, a detailed clinical assessment reduces the likelihood of post-procedure PTX and makes routine chest X-ray imaging unnecessary. Conversely, clinical follow-up of these patients in terms of PTX should be essential for possible complications. However, clinical signs of late PTX development in the first 24–48 h after chest tube removal in patients undergoing redo cardiac surgery should be followed carefully by the clinician, and chest X-ray imaging should be routinely performed.