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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: [email protected]
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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

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