Cyanotic Congenital Cardiac Disease and Scoliosis: Pre-Operative Assessment, Surgical Treatment, and Outcomes

Incidence of cardiac anomalies in congenital vertebral deformity: systematic review and meta-analysis of 2910 patients

PURPOSE

This study aimed to analyze the overall incidence of cardiac abnormalities in patients with congenital scoliosis and the possible influencing factors.

METHODS

PubMed, Embase, and Cochrane Library were searched for relevant studies. The quality of the studies was assessed independently by two authors using the methodological index for nonrandomized studies (MINORS) criteria. The following data were extracted from the included studies: bibliometric data, number of patients, number of patients with cardiac anomalies, gender, types of deformity, diagnostic method, type of cardiac anomaly, location, and other associated anomalies. The Review Manager 5.4 software was used to group and analyze all the extracted data.

RESULTS

This meta-analysis included nine studies and identified that 487 of 2,910 patients with congenital vertebral deformity had cardiac anomalies diagnosed by ultrasound (21.05%, 95% CI of 16.85-25.25%). The mitral valve prolapse was the most frequent cardiac anomaly (48.45%) followed by an unspecified valvular anomaly (39.81) and an atrial septal defect (29.98). A diagnosis of cardiac anomalies was highest in Europe (28.93%), followed by USA (27.21%) and China (15.33%). Females and formation defects were factors significantly associated with increased incidence of cardiac anomalies: 57.37%, 95% CI of 50.48-64.27% and 40.76%, 95% CI of 28.63-52.89%, respectively. Finally, 27.11% presented associated intramedullary anomalies.

CONCLUSIONS

This meta-analysis revealed that the overall incidence of cardiac abnormalities detected in patients with congenital vertebral deformity was 22.56%. The incidence rate of cardiac anomalies was higher in females and those with formation defects. The study offers guidance for ultrasound practitioners to accurately identify and diagnose the most common cardiac anomalies.

Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010-2020 in a National Spinal Centre

Bracing can reduce curve progression in order to prevent or delay scoliosis surgery in growing children. Brace treatment is effective in adolescent idiopathic scoliosis (AIS), but there is less evidence of its efficacy in early-onset or non-idiopathic scoliosis. We assessed the outcome of bracing at the end point of treatment, including the patients' perception of clinical results. We reviewed 480 patients treated using Boston brace from 2010-2020 (70% female); 249 patients completed bracing (52%) and 118 patients (47.4%) did not require surgery, with 83% having idiopathic scoliosis. Brace success was considered scoliosis below 50° at the end of bracing, with the patient skeletally mature. A total of 131 patients required scoliosis surgery after bracing (64% had idiopathic scoliosis; adolescents 57% and juveniles 43%). All patients had a minimum two-year follow-up after bracing or after scoliosis correction, with the quality of life assessment questionnaires. A total of 98 out of 182 patients with idiopathic scoliosis did not require surgery (54%). Thoracic scoliosis improved with bracing by a mean of 3.4° and thoracolumbar/lumbar scoliosis by a mean of 6.8°. A total of 85 patients with AIS (64%) but only 9 patients with JIS (20%) did not need surgery. In the AIS group, 97 patients had scoliosis of 20-40°; 71 of these patients (73.2%) did not require scoliosis correction at the end of bracing. In total, 84 patients with idiopathic scoliosis had surgery at a mean of 14 years (surgery was delayed by a mean of 3.2 years). In total, 20 of 67 patients with non-idiopathic scoliosis did not need surgery (30%). Thoracic scoliosis improved with bracing by a mean of 8.4° and thoracolumbar/lumbar scoliosis by a mean of 0.8°. A total of 47 patients with non-idiopathic scoliosis required surgery at a mean of 13.1 years (surgery was delayed by a mean of 5.2 years). Multivariate regression analysis showed that idiopathic scoliosis, AIS, closed triradiate cartilage, post-menarche status, higher Risser grade and smaller scoliosis angle at initial presentation predicted brace success. Patients reported good function and self-image, reduced pain and high satisfaction after treatment in both the bracing-only and the bracing followed by surgery groups.

Hemoptysis due to progressive scoliosis associated with congenital heart disease: a case report

Background

Patients with congenital heart disease (CHD) are associated with an increased incidence of scoliosis, often with severe progression. We report a case of hemoptysis caused by rapid scoliosis progression subsequent to surgery for CHD that was successfully managed by surgical curve correction following coil embolization.

Case presentation

A 14-year-old girl with scoliosis had undergone open heart surgery for CHD at the age of 1 year. She was first noted to have scoliosis at 12 years of age, which began to progress rapidly. At age 13, her main thoracic curve Cobb angle was 46°, and hemoptysis with high pulmonary vein pressure due to vertebral rotation was detected. Nine months after coil embolization, she received posterior spinal fusion from T5 to L2 for scoliosis correction. Postoperatively, her pulmonary vein diameter was enlarged, with no detectable signs of hemoptysis.

Conclusions

We encountered a case of hemoptysis caused by advanced scoliosis after cardiac surgery that was successfully treated by correction of the scoliotic curve following coil embolization. Patients with secondary scoliosis after surgery for CHD should be carefully monitored for the possibility of cardiovascular system deterioration.

Conservative treatment of a scoliosis patient after two heart surgeries in early childhood - A case report

Introduction

This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).

Patient presentation, management and outcome

Initially, the premenarchial female was 9 years old and had a Tanner stage 2–3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.

Conclusion

Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.

Clinical implications

Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

Surgical Correction of Scoliosis in Children with Severe Congenital Heart Disease and Palliated Single Ventricle Physiology

STUDY DESIGN

Case series.

OBJECTIVE

In this study we focus on this group, and describe the largest cohort to date of single ventricle patients undergoing surgical correction of scoliosis at a single institution.

SUMMARY OF BACKGROUND DATA

Outcomes of spinal surgery for patients with congenital heart disease (CHD) have evolved and most affected patients have uncomplicated procedures. The risk of perioperative complications remains highest in patients with single ventricle ("Fontan") physiology.

METHODS

We reviewed patients with single ventricle CHD and operative scoliosis repair over a 25-year span. Patients who had undergone a Fontan, bidirectional Glenn, and/or Kawashima procedure before operative scoliosis repair were included. Patients were excluded if they lacked preoperative cardiac care and/or sufficient medical history at our institution.

RESULTS

Twenty-three patients were included. The average age at surgery was 13.6 years (range, 5-23). Seventy percent of the cohort was female (16/23). The majority of patients underwent a Fontan before scoliosis surgery (20/23, 87%). Patients without intraoperative tranexamic acid (TXA) had a 67% complication rate (8/12) versus 36% (4/11) in those with intraoperative TXA (P = 0.29). There was a significant difference in estimated blood loss by weight (cc/kg) between non-TXA and TXA patients (P = 0.016). Twelve patients experienced complications (52%), all of which occurred postoperatively. There were no deaths, cerebrovascular events, adverse perioperative cardiac or hemodynamic complications, or wound infections. Using the Clavien-Dindo-Sink classification for postoperative complications, four patients had serious adverse events, including one permanent neurologic deficit.

CONCLUSION

Spinal surgery for scoliosis has been performed in selected patients with single ventricle physiology at a single institution without mortality for 25 years. Operative blood loss may be reduced by routine use of TXA. Complications occur most commonly in the postoperative period, and can include pleural effusion.Level of Evidence: 4.