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


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.


CONCLUSIONS
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.
Pérez-Caballero
César
C
Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain. cesarperezcaballero@yahoo.es
Sobrino
Elena
E
Vázquez
José Luis
JL
Burgos
Jesús
J
Alvarez
Elena
E
Martos
Isabel
I
Fernández
Luis
L
Vellibre
Diego
D