Scoliosis in Children after Surgery for Congenital Heart Disease

Abstract

Study Design : A retrospective study. Objectives : To analyze natural history and clinical features of scoliosis developed after surgery for congenital heart disease and to investigate the influence of cardiac surgery on the onset and progression of scoliosis.. Materials and methods : Three hundred and five patients who had been operated for congenital heart disease from Jan.1988 to Dec.1990 and followed up for more than 5 years were analyzed. The curve which was more than 10 on radiography was defined as significant scoliosis and the patients with congenital spinal anomalies were excluded. We compared age at surgery, cardiac disease and effect of cyanosis between scoliosis and non-scoliosis group. Furthermore, in scoliosis group, prevalence, onset of significant scoliosis, and manifestation of curve according to side of thoracotomy were assessed. Results : Fifty-six patients(18.4%) had scoliosis of more than 10 . As for location, high thoracic in 19, thoracic in 23, double thoracic in 8, thoraco-lumbar in 5 and double major in 1. Of the 42 patients with thoracic or high thoracic curves, 17(40%) showed convexity to the left. The magnitudes of curves were less than 40 degrees except 1. There was no significant difference in prevalence(p=0.513) and Cobb angle(p=0.634) between cyanosis and acyanosis group. Scoliosis developed between 3 and 6 years after cardiac operation in 26 patients(46%). In high thoracic curve, 6 of 7 patients with left thoracotomy demonstrated convexity to the left and 5 of 6 patients with right thoracotomy demonstrated convexity to the right(p=0.026). Conclusions : The prevalence of scoliosis after surgery for congenital heart disease was 18.4%. High thoracic and left thoracic curves were more frequent compared to idiopathic curves and a half of them developed 3 to 6 years after cardiac surgery. Most patients did not have severe curve to need surgical intervention and there was no correlation between severity of scoliosis and age at cardiac operation and cyanosis. In high thoracic curve, the tendency for the curve to be convex to the side of cardiac approach was demonstrated.