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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]
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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 

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