Cardiol Young 2009; 19: 272–277 r Cambridge University Press ISSN 1047-9511 doi:10.1017/S1047951109004004 First published online 6 April 2009 Original Article Complication of surgery for scoliosis in children with surgically corrected congenital cardiac malformations Ce ´sar Pe ´rez-Caballero, 1 Elena Sobrino, 1 Jose ´ Luis Va ´zquez, 1 Jesu ´s Burgos, 2 Elena A ´ lvarez, 1 Isabel Martos, 1 Luis Ferna ´ndez, 3 Diego Vellibre 1 1 Paediatric Intensive Care Unit; 2 Department of Paediatric Orthopaedics; 3 Department of Paediatric Cardiology. Hospital Ramo´n y Cajal, Madrid, Spain Abstract Introduction: 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. Materials and 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. Conclusion: 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. Keywords: Congenital cardiac malformations; paediatric spinal deformity; cardiac surgery; postoperative management; complications I N BROAD TERMS, 1% OF NEWBORN BABIES HAVE congenitally malformed hearts. The lesions are considered to have a multifactorial aetiology, and treatment is frequently surgical, either by thor- acotomy or sternotomy, depending on the specific cardiac lesion. Such patients, having undergone cardiothoracic surgery, are known to have a higher risk of developing scoliosis, with over two-fifths reported to develop this complication in some series, 1 compared to no more than 2 to 3% of the general population. 2 The aetiology of the develop- ing scoliosis is unknown. 3 although various factors have been implicated. These range from the suggestion that the vascular anomalies that exist in cyanotic congenital cardiac disease could produce abnormal irrigation of the spine, to the possibility that the thoracic deformity caused by the sternot- omy and the thoracotomy could impact on the structure of the spine. In fact, the incidence of scoliosis after a combined sternotomy and thor- acotomy is 10 times greater than that of idiopathic scoliosis. 4,5 It has also been suggested that the association between the embryonic development of the cardiovascular and musculoskeletal systems could account for the high incidence of scoliosis in these children. Despite these speculations, it Correspondence to: Dr Ce ´sar Pe ´rez-Caballero Macarro ´n, Unidad de Cuidados Intensivos Pedia ´tricos, Hospital Ramo ´n y Cajal, Cta. Colmenar Km. 9.300. 28034 Madrid. Spain. Tel: (034) 639178762; Fax: (034) 913368417; E-mail: cesarperezcaballero@yahoo.es Accepted for publication 17 February 2009