Tratamiento quirúrgico de la escoliosis en pacientes con circulación de Fontan.

Orthopedic Surgery, Children's Hospital/Harvard Medical School, Boston, MA 02115, USA. daniel.hedequist@childrens.harvard.edu

STUDY DESIGN: A retrospective chart and radiographic review of patients with a Fontan physiology who underwent surgical correction of their scoliosis.

OBJECTIVE: To evaluate the operative and perioperative treatment of patients with a Fontan physiology and scoliosis.

SUMMARY OF BACKGROUND DATA: The survival rates in patients with complex congenital heart disease are improving, thus creating a subset of patients with complex physiology who will require surgical treatment of their scoliosis. The Fontan physiology is created surgically in patients born with a single functioning ventricle. These patients represent a significant anesthetic risk during spinal surgery, given their physiologic need for a sustained systemic preload. Currently, to our knowledge, there are no published series in the literature regarding the operative treatment of scoliosis in these patients.

METHODS: We reviewed our experience with the operative treatment of scoliosis in 7 patients with a Fontan circulation. There were 7 patients identified who were treated with correction and arthrodesis using modern segmental instrumentation. A radiographic and chart review was performed to assess the operative and perioperative treatment.

RESULTS: Mean age at surgery was 14 years 9 months, and mean Cobb angle was 75 degrees . There were no intraoperative complications; however, postoperative complications were frequent and significant: 1 delayed paralysis, 2 superior mesenteric artery syndromes, 1 renal tubular necrosis, 2 pulmonary complications, 1 Horner syndrome, and 1 urinary tract infection.

CONCLUSIONS: Operative treatment of scoliosis in these patients may be successful; however, complications are frequent and significant.