Cyanotic Congenital Cardiac Disease and Scoliosis: Pre-operative Assessment, Surgical Treatment and Outcomes

Athanasios I Tsirikos, George Augustithis, Greg McKean, Christos Karampalis
Medical Principles and Practice: International Journal of the Kuwait University, Health Science Centre 2019 July 3

OBJECTIVE: Congenital heart disease (CHD) is associated with the development of scoliosis. Improvements in cardiac care have extended survival of children with cyanotic CHD which possess a need for correction of scoliosis. There is limited information on spinal care for these patients. We present 3 patients with CHD who underwent surgical correction of scoliosis.

MATERIALS AND METHODS: We reviewed demographic and clinical data on patients with cyanotic CHD.

RESULTS: Patient 1 underwent posterior spinal fusion T3-L3 at age of 16 years. He had a double inlet left ventricle and was treated with completion of a Fontan circulation. Hypotensive anaesthesia was used but he lost 3000 ml of blood. Operative time was 370 minutes and most of the blood loss occurred in the second half of the procedure. Patient 2 underwent posterior spinal fusion T5-T12 when aged 14 years. She had transposition of the great vessels corrected over multiple surgeries. Hypotensive anaesthesia was used and she had blood loss of 300 ml, and the surgical time was 282 minutes. Patient 3 underwent posterior spinal fusion extending from T5-T12 when he was 17 years old. He had a double inlet left ventricle and was treated with completion of a Fontan circulation. Hypotensive anaesthesia was used and he had blood loss of 1021 ml and surgical time 342 minutes.

CONCLUSION: Scoliosis surgery in patients with complex cardiac disease may be indicated to treat progressive deformities which produce severe symptoms. A multidisciplinary approach including a spinal surgeon, as well as a cardiologist, haematologist, respiratory paediatrician and spinal anaesthetist can evaluate the general medical condition and weigh the benefits and risks of surgery. Deformity correction can be performed using a meticulous technique and has produced a series of satisfactory outcomes.

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