title: The findings of preoperative cardiac screening studies in adolescent idiopathic scoliosis.
abstract: BACKGROUND
  We sought to evaluate findings of screening cardiac studies in adolescent idiopathic scoliosis (AIS) patients by reviewing the echocardiograms and electrocardiograms (EKGs) performed at their preoperative evaluation for spinal fusion.
  
  
  METHODS
  Retrospective chart review of all surgical AIS patients from 2000 to 2007 was completed (n=212). Patients with neuromuscular scoliosis, known connective tissue disease, or known/suspected cardiac disease were excluded. In presurgical screening, 12 lead EKG, 2dimensional-Doppler, and M-mode echocardiograms were analyzed.
  
  
  RESULTS
  A total of 154 (73%) female and 58 (27%) male patients (aged 12 to 18 y, avg: 14.8 y) were analyzed. EKG findings, 180/212 (85%), were within normal limits. Twenty-eight of 212 (13%) patients were found to have normal variant readings. Four of 212 (2%) patients met criteria for left ventricular hypertrophy on EKG, but were subsequently found to have normal echocardiograms. Significant echocardiogram findings revealed 2 (0.94%) subjects with atrial septal defects (ASDs) (that delayed surgery) and 7 (3.3%) subjects with aortic root/valve abnormalities.
  
  
  CONCLUSIONS
  In our cohort of preoperative AIS patients, cardiac abnormalities ranged from mild to severe, and in 2 cases, affected the surgical timing. Novel findings of aortic abnormalities were identified in 3.3% of patients. In a study which examined the prevalence of heart disease in randomly selected healthy adolescents with previously unknown cardiac disease (Steinberger), there was a rate of 3.6% (13/357) of cardiac anomalies. Of note, only 0.6% had aortic root/valve findings. The results of our retrospective review indicate that EKG does not provide significant information compared with echocardiogram as part of the preoperative evaluation of asymptomatic and otherwise healthy patients with AIS who are undergoing spinal deformity surgery. However, use of the echocardiogram may be appropriate for the diagnosis of previously unknown cardiac abnormalities in this population, as aortic root/valve abnormalities seem to be unique findings in these patients.
  
  
  METHODS
  Level IV, Retrospective, descriptive case series.
authors.affiliation: The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. ippl@hss.edu
authors.forename: Lisa
authors.initials: L
authors.lastname: Ipp
authors.forename: Patrick
authors.initials: P
authors.lastname: Flynn
authors.forename: John
authors.initials: J
authors.lastname: Blanco
authors.forename: Daniel
authors.initials: D
authors.lastname: Green
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.forename: Jeanine
authors.initials: J
authors.lastname: Kozich
authors.forename: Gilbert
authors.initials: G
authors.lastname: Chan
authors.forename: John
authors.initials: J
authors.lastname: Denneen
authors.forename: Roger
authors.initials: R
authors.lastname: Widmann
mesh_terms: D000293:Adolescent; D002648:Child; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*