Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-29T07:32:55.935Z Has data issue: false hasContentIssue false
  • English
  • Français

Complication of surgery for scoliosis in children with surgically corrected congenital cardiac malformations

Published online by Cambridge University Press:  06 April 2009

César Pérez-Caballero ,
Elena Sobrino ,
José Luis Vázquez ,
Jesús Burgos ,
Elena Álvarez ,
Isabel Martos ,
Luis Fernández  and
Diego Vellibre
César Pérez-Caballero*
Affiliation:
Paediatric Intensive Care Unit
Elena Sobrino
Affiliation:
Paediatric Intensive Care Unit
José Luis Vázquez
Affiliation:
Paediatric Intensive Care Unit
Jesús Burgos
Affiliation:
Department of Paediatric Orthopaedics
Elena Álvarez
Affiliation:
Paediatric Intensive Care Unit
Isabel Martos
Affiliation:
Paediatric Intensive Care Unit
Luis Fernández
Affiliation:
Department of Paediatric Cardiology. Hospital Ramón y Cajal, Madrid, Spain
Diego Vellibre
Affiliation:
Paediatric Intensive Care Unit
*
Correspondence to: Dr César Pérez-Caballero Macarrón, Unidad de Cuidados Intensivos Pediátricos, Hospital Ramón y Cajal, Cta. Colmenar Km. 9.300. 28034 Madrid. Spain. Tel: (034) 639178762; Fax: (034) 913368417; E-mail: cesarperezcaballero@yahoo.es
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

There is a high incidence of scoliosis in patients who have undergone cardiothoracic surgery for correction of congenital cardiac disease, this risk being 10 times higher than in the general population.

Materials and methods

So as to analyse the surgical and postoperative complications, we designed a retrospective study to include every child who underwent spinal orthopaedic surgery, and who had previously undergone cardiothoracic surgery because of a congenital cardiac malformation. We excluded those patients who had syndromes associated with the development of scoliosis.

Results

We identified 18 patients with surgically treated congenital cardiac disease who had undergone surgery for scoliosis over a period of 7 years. This group came from a total number of 87 patients undergoing spinal fusion over the same period. Of those with congenitally malformed hearts, 61% had acyanotic lesions, with ventricular septal defect being the most frequent single lesion, present in 40%. All the patients needed blood transfusions during the surgery, with aprotinin used in 73% to reduce the bleeding, and inotropes needed for 4 children. During the immediate postoperative period, 1 patient died in the first 24 hours, while 7 (39%) had different complications, pneumonia in 4, pleural effusions in 2, and rhabdomyolysis in the other, as opposed to a rate of complications of 27% in patients without heart disease.

Conclusion

The surgical and postoperative complications in these patients depend on the specific cardiac lesion. A multidisciplinary team with experience in the treatment of congenitally malformed hearts is essential for appropriate management of these patients.

Keywords

Congenital cardiac malformationspaediatric spinal deformitycardiac surgerypostoperative managementcomplications
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 3 , June 2009 , pp. 272 - 277
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Van Biezen, FC, Bakx, PA, De Villeneuve, VH, Hop, WC. Scoliosis in children after thoracotomy for aortic coarctation. J Bone Joint Surg Am 1993; 75: 514–518.CrossRefGoogle ScholarPubMed
2. Drennan, JC, Campbell, JB, Ridge, H. Denver: a metropolitan public school scoliosis survey. Pediatrics 1977; 60: 193–196.CrossRefGoogle Scholar
3. Pérez-Caballero, C, Burgos, J, Martos, I, et al. Complicaciones médicas precoces en el postoperatorio de cirugía de escoliosis. An Pediatr (Barc) 2006; 64: 248–251.Google Scholar
4. Ruiz-Iban, MA, Burgos, J, Aguado, HI, et al. Scoliosis after median sternotomy in children with congenital Heart Disease. Spine 2005; 30: 214–218.CrossRefGoogle ScholarPubMed
5. Herrera-Soto, JA, Santiago-Cornier, A, Segal, LS, Ramírez, N, Tamai, J. Spinal deformity after combined thoracotomy and sternotomy for congenital heart disease. J Pediatr Orthop 2006; 26: 211–215.Google Scholar
6. Farley, FA, Phillips, WA, Herzenberg, JE, Rosenthal, A, Hensinger, RN. Natural history of scoliosis in congenital heart disease. J Pediatr Orthop 1991; 11: 42–47.CrossRefGoogle ScholarPubMed
7. Marino, BS. Outcomes after the Fontan procedure. Curr Opin Pediatr 2002; 14: 620–626.CrossRefGoogle ScholarPubMed
8. Coran, DL, Rodgers, WB, Keane, JF, Hall, JE, Emans, JB. Spinal fusion in patients with congenital heart disease. Predictors of outcome. Clin Orthop 1999; 364: 99–107.CrossRefGoogle Scholar
9. Pérez-Caballero, C, Burgos, J, Martos, I, et al. Estudio comparativo de las complicaciones postoperatorias inmediatas de la toracoscopia frente a la toracotomía en la escoliosis idiopática infantil. An Pediatr (Barc) 2006; 65: 569–572.CrossRefGoogle Scholar
10. Cobb, JR. Outline for the study of scoliosis. Instr Course Lect 1948; 5: 261–275.Google Scholar
11.American Electroencephalographic Society guidelines for intraoperative monitoring of sensory evoked potentials. J Clin Neurophysiol 1994; 11: 77–87.Google Scholar
12. Comisión de la sociedad española de neurofisiología clínica. Guía práctica para la realización de la monitorización neurofisiológica de la cirugía de la columna. Rev Neurol 2004; 38: 879–885.Google Scholar
13. Alterman, I, Sidi, A, Azamfirei, L, Copotoiu, S, Ezri, T. Rhabdomyolysis: another complication after prolonged surgery. J Clin Anesth Reanim 2007; 19: 64–66.Google Scholar
14. Lachiewicz, P, Latimer, HA. Rhabdomyolysis following total hip arthroplasty. J Bone Joint Surg Br 1991; 73: 576–579.CrossRefGoogle ScholarPubMed
15. Perloff, JK. Congenital heart disease in adults: A new cardiovascular specialty. Circulation 1991; 84: 1881–1890.Google Scholar
16. Primiano, FP, Nussbuaum, E, Hirschfeld, SS, et al. Early echocardiographic and pulmonary function findings in idiopathic scoliosis. J Pediatr Orthop 1983; 3: 475–481.CrossRefGoogle ScholarPubMed
17. Durning, RP, Scoles, PV, Fox, OD. Scoliosis after thoracotomy in tracheoesophageal fistula patients. A follow-up study. J Bone Joint Surg Am 1980; 62: 1156–1159.Google Scholar
18. Wright, WD, Niebauer, JJ. Congenital heart disease and scoliosis. J Bone Joint Surg Am 1956; 38-A: 1131–1136.CrossRefGoogle Scholar
19. Herrera-Soto, JA, Vander Have, KL, Barry-Lane, P. Thoracic surgery, congenital heart disease and developmental scoliosis. Presented at 1st International POSNA/AAOS Pediatric Orthopaedic Symposium. Orlando, FL. 2004.Google Scholar
20. Gilsanz, V, Boechat, IM, Birnberg, FA, King, JD. Scoliosis after thoracotomy for esophageal atresia. AJR Am J Roentgenol 1983; 141: 457–460.Google Scholar
21. Hedequist, DJ, Emans, JB, Hall, JE. Operative treatment of scoliosis in patients with a Fontan circulation. Spine 2006; 31: 202–205.Google Scholar
22. Stafford, MA, Henderson, KH. Anesthetic morbidity in congenital heart patients undergoing non-cardiac surgery. Anesthesiology 1991; A-75: 1056. Abstract.CrossRefGoogle Scholar
23. Hennein, HA, Mendeloff, EN, Cilley, RE, Bove, EL, Coran, AG. Predictors of postoperative outcome after general surgical procedures in patients with congenital heart disease. J Pediatr Surg 1994; 29: 866–870.Google Scholar
24. Bitan, F, Rigault, P, Houfani, B, et al. Scoliosis and congenital heart disease in children: Apropos of 44 cases. Rev Chir Orthop Reparatrice Appar Mot 1991; 77: 179–188.Google Scholar
25. Mahdy, AM, Webster, NR. Perioperative systemic hemostatic agents. Br J Anesth 2004; 93: 842–858.Google Scholar
26. Lentschener, C, Cottin, P, Bouaziz, H, et al. Reduction of blood loss and transfusion requirement by aprotinin in posterior lumbar spine fusion. Anesth Analg 1999; 89: 590–597.Google Scholar
27. Florentino-Pineda, I, Blakemore, LC, Thompson, GH, Poe-Kochert, C, Adler, P, Tripi, P. The effect of epsilon-aminocaproic acid on perioperative blood loss in patients with idiopathic scoliosis undergoing posterior spinal fusion: a preliminary prospective study. Spine 2001; 26: 1147–1151.Google Scholar
28. Rafique, MB, Stuth, EA, Tassone, JC. Increased blood loss during posterior spinal fusion for idiopathic scoliosis in adolescence with Fontan physiology. Paediatr Anaesth 2006; 16: 206–212.Google Scholar
29. Florentino-Pineda, I, Thompson, GH, Poe-Kochert, C, Huang, RP, Haber, LL, Blakemore, LC. The effect of amicar on perioperative blood loss in idiopathic scoliosis: the result of a prospective, randomized double blind study. Spine 2004; 29: 233–238.Google Scholar
30. Tobias, JD. Synthetic factor VIIa to treat dilutional coagulopathy during posterior spinal fusion in two children. Anesthesiology 2002; 96: 1522–1525.CrossRefGoogle ScholarPubMed