title: Spinal surgery in the univentricular heart--is it viable?
abstract: BACKGROUND
  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.
  
  
  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.
authors: 1 Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors: C
authors: C
authors: Pérez-Caballero Macarrón
authors: 1 Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors: E
authors: E
authors: Sobrino Ruiz
authors: 2 Department of Paediatric Orthopaedics, Hospital Ramón y Cajal, Madrid, Spain.
authors: J
authors: J
authors: Burgos Flores
authors: 1 Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors: Jl
authors: J
authors: Vázquez Martínez
authors: 1 Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors: A
authors: A
authors: Coca Pérez
authors: 1 Paediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain.
authors: E
authors: E
authors: Alvarez Rojas
authors: 2 Department of Paediatric Orthopaedics, Hospital Ramón y Cajal, Madrid, Spain.
authors: Jj
authors: J
authors: Sánchez Ruas
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D004298:Dopamine / Q000627:therapeutic use; D004310:Double Outlet Right Ventricle / Q000150:complications / Q000601:surgery; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000628:therapy; D018633:Pulmonary Atresia / Q000150:complications / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000150:complications / Q000601:surgery; D014264:Tricuspid Valve Stenosis / Q000150:complications / Q000601:surgery; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents; D004298:Dopamine