Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-24T08:59:27.850Z Has data issue: false hasContentIssue false
  • English
  • Français

Spinal surgery in the univentricular heart – is it viable?

Published online by Cambridge University Press:  07 February 2013

C. Pérez-Caballero Macarrón ,
E. Sobrino Ruiz ,
J. Burgos Flores ,
JL. Vázquez Martínez ,
A. Coca Pérez ,
E. Álvarez Rojas  and
JJ. Sánchez Ruas
C. Pérez-Caballero Macarrón*
Affiliation:
Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain
E. Sobrino Ruiz
Affiliation:
Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain
J. Burgos Flores
Affiliation:
Department of Paediatric Orthopaedics, Hospital Ramón y Cajal, Madrid, Spain
JL. Vázquez Martínez
Affiliation:
Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain
A. Coca Pérez
Affiliation:
Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain
E. Álvarez Rojas
Affiliation:
Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain
JJ. Sánchez Ruas
Affiliation:
Department of Paediatric Orthopaedics, Hospital Ramón y Cajal, Madrid, Spain
*
Correspondence to: Dr César Pérez-Caballero Macarrón, Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Cta. Colmenar Km 9.300, 28034 Madrid, Spain. Tel: (034) 913368560; Fax: (034) 913368417; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

The management of patients with Fontan physiology who undergo scoliosis surgery is difficult. The purpose of this article was to describe our experience in the management of patients with Fontan circulation undergoing spinal surgery for correction of scoliosis.

Materials and methods

This was a retrospective study including patients with Fontan physiology who underwent spinal orthopaedic surgery. Anaesthetic management, post-operative complications, paediatric intensive care unit and total hospital stay, and the need for blood transfusions were analysed.

Results

We identified eight children with Fontan physiology who had undergone spinal surgery from 2000 to 2010. All patients were receiving cardiac medications at the time of spinal surgery. The mean age at surgery was 14.8 years (range 12–21). In all, three patients needed inotropic support with dopamine (3, 5, and 8 μg/kg/min), which was started during surgery. During the immediate post-operative period, one patient died because of hypovolaemic shock caused by massive bleeding and dysrythmia. Mean blood loss during the post-operative period was 22.2 cc/kg (7.8–44.6). Surgical drainages were maintained for a mean time of 3 days (range 1–7). The mean hospital stay was 9.2 days (range 6–19). Pleural effusions developed in two patients. On follow-up, one patient presented with thoracic pseudarthrosis and another with a serohaematoma of the surgical wound.

Conclusions

Spinal surgery in patients with Fontan circulation is a high-risk operation. These patients must be managed by a specialised team.

Keywords

Congenital cardiac malformationsFontan physiologycardiac surgeryscoliosispost-operative managementcomplications
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 1 , February 2014 , pp. 73 - 78
Copyright
Copyright © Cambridge University Press 2013 

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. Herrera-Soto, JA, Vander Have, KL, Barry-Lane, P, Woo, A. Spinal deformity after combined thoracotomy and sternotomy for congenital heart disease. J Pediatr Orthop 2006; 26: 211–215.CrossRefGoogle ScholarPubMed
2. Marino, BS. Outcomes after the Fontan procedure. Curr Opin Pediatr 2002; 14: 620–626.CrossRefGoogle ScholarPubMed
3. Coran, DL, Rodgers, WB, Keane, JF, et al. Spinal fusion in patients with congenital heart disease: predictors of outcome. Clin Orthop Relat Res 1999; 364: 99–107.Google Scholar
4. Pérez-Caballero, C, Sobrino, E, Vázquez, JL, et al. Complication of surgery for scoliosis in children with surgically corrected congenital cardiac malformations. Cardiol Young 2009; 19: 272–277.Google Scholar
5. Cromme-Dijkhuis, AH, Hess, J, Hahlen, K, et al. Specific sequelae after Fontan operation at mid- and long term follow up. Arrhythmia, liver dysfunction, and coagulation disorders. J Thorac Cardiovasc Surg 1993; 106: 1126–1132.Google Scholar
6. Cobb, JR. Outline for the study of scoliosis. Instr Course Lect 1948; 5: 261–275.Google Scholar
7. Meyer, S. Grading of patients for surgical procedures. Anesthesiology 1941; 2: 281–285.Google Scholar
8. The American electroencephalographic society guidelines for intraoperative monitoring of sensory evoked potentials. J Clin Neurophysiol 1994; 11: 77–87.CrossRefGoogle Scholar
9. Vallespir, GP, Flores, JB, Trigueros, IS, et al. Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine 2008; 33: 1588–1597.Google Scholar
10. Ruiz-Iban, MA, Burgos, J, Aguado, AJ, et al. Scoliosis after median sternotomy in children with congenital heart disease. Spine 2005; 30: E214–E218.CrossRefGoogle ScholarPubMed
11. Kawakami, N, Mimatsu, K, Deguchi, M, et al. Scoliosis and congenital heart disease. Spine 1995; 20: 1252–1255.Google Scholar
12. Basu, PS, Elsebaie, H, Noordeen, MH. Congenital spinal deformity: a comprehensive assessment at presentation. Spine 2002; 27: 2255–2259.Google Scholar
13. Bal, S, Elshershari, H, Celiker, R, et al. Thoracic sequels after thoracotomies in children with congenital cardiac disease. Cardiol Young 2003; 13: 264–267.CrossRefGoogle ScholarPubMed
14. Herrera-Soto, JA, Vander Have, KL, Barry-Lane, P, et al. Retrospective study on the development of spinal deformities following sternotomy for congenital heart disease. Spine 2007; 32: 1998–2004.CrossRefGoogle ScholarPubMed
15. Ohye, RG, Bove, EL. Advances in congenital heart surgery. Curr Opin Pediatr 2001; 13: 473–481.Google Scholar
16. Taggart, NW, Shaughnessy, WJ, Stans, AA, McIntosh, AL, Driscoll, DJ. Outcomes of spinal fusion in children with congenital heart disease. J Pediatr Orthop 2010; 30: 670–675.Google Scholar
17. Weiss, HR, Goodall, D. Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature. Scoliosis. 2008; 3: 9, doi: 10.1186/1748-7161-3-9Google Scholar
18. Coe, JD, Arlet, V, Donaldson, W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine 2006; 31: 345–349.Google Scholar
19. Hedequist, DJ, Emans, JB, Hall, JE. Operative treatment of scoliosis in patients with a Fontan circulation. Spine 2006; 31: 202–205.Google Scholar
20. Vischoff, D, Fortier, LP, Villeneuve, E, et al. Anaesthetic management of an adolescent for scoliosis surgery with a Fontan circulation. Paediatr Anaesth 2001; 11: 607–610.CrossRefGoogle ScholarPubMed
21. Florentino-Pineda, I, Thompson, GH, Poe-Kochert, C, et al. The effect of amicar on perioperative blood loss in idiopathic scoliosis: the results of a prospective, randomized double-blind study. Spine 2004; 29: 233–238.Google Scholar
22. Odegard, KC, McGowan, FX, DiNardo, JA, et al. Coagulation abnormalities in patients with single ventricle physiology precede the Fontan procedure. J Thorac Cardiovasc Surg 2002; 123: 459–465.Google Scholar
23. Tobias, JD. Synthetic factor VIIa to treat dilutional coagulopathy during posterior spinal fusion in two children. Anesthesiology 2002; 96: 1522–1525.Google Scholar
24. Mahdy, AM, Webster, NR. Perioperative systemic hemostatic agents. Br J Anaesth 2004; 93: 842–858.CrossRefGoogle Scholar
25. Rafique, MB, Stuth, E, Tassone, C. Increased blood loss during posterior spinal fusion for idiopathic scoliosis in an adolescent with Fontan physiology. Pediatr Anesth 2006; 16: 206–212.CrossRefGoogle Scholar
26. Balling, G, Vogt, M, Kaemmerer, H, et al. Intracardiac thrombus formation after the Fontan operation. J Thorac Cardiovasc Surg 2000; 119: 745–752.Google Scholar