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Thoracic sequels after thoracotomies in children with congenital cardiac disease

Published online by Cambridge University Press:  24 May 2005

Serpil Bal ,
Huda Elshershari ,
Reyhan Çeliker  and
Alpay Çeliker
Serpil Bal
Affiliation:
Department of Physical Medicine & Rehabilitation, Hacettepe University, Ankara, Turkey
Huda Elshershari
Affiliation:
Department of Paediatrics, Hacettepe University, Ankara, Turkey
Reyhan Çeliker
Affiliation:
Department of Physical Medicine & Rehabilitation, Hacettepe University, Ankara, Turkey
Alpay Çeliker
Affiliation:
Department of Paediatrics, Hacettepe University, Ankara, Turkey
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Abstract

The standard surgical approach for closed heart procedures in small infants and children is to use a posterolateral thoracotomy incision, which results in the division of the latissimus dorsi and serratus anterior muscles. The aim of our study was to determine the frequency and type of musculoskeletal deformities in children undergoing surgery with this approach for congenital cardiac disease.

We included 49 children, 28 boys and 21 girls, in the study. Their mean age was 10.2 ± 4.8 years, the mean age at the time of surgery was 3.8 ± 4.0 years, and they were evaluated at an average of 6 years after the thoracotomy. Of the patients, 94% had various musculoskeletal deformities. Scoliosis was observed in 15 patients (31%) but only in two patients did the curves exceed 25 degrees. Of these patients, three-fifths had aortic coarctation. Elevation of the shoulder was seen in 61%, winged scapula in 77%; while 14% had asymmetry of the thoracic wall due to the atrophy of the serratus anterior muscle. Deformity of the thoracic cage was observed in 18%; and 63% had asymmetry of the nipples.

Thus, we found that musculoskeletal deformities are frequent after thoracotomies in children with congenital cardiac disease. Patients who have undergone such procedures for cardiac or noncardiac surgery should be followed until their skeletal maturation is complete. Techniques sparing the serratus anterior and latissimus dorsi muscles should be preferred. These adverse effects of thoracotomy may be another reason for using interventional procedures in these cases.

Keywords

Scoliosiswing scapulapulmonary problems
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 3 , June 2003 , pp. 264 - 267
Copyright
© 2003 Cambridge University Press

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References

Van Biezen FC, Bakx PA, De Villeneuve VH, Hop WC. Scoliosis in children after thoracotomy for aortic coarctation. Bone Joint Surg Am 1993; 75: 514–518.Google Scholar
Jordan CE, White RI Jr, Fischer KC, Neill C, Dorst JP. The scoliosis of congenital heart disease. Am Heart J 1972; 84: 463–469.Google Scholar
Luke MJ, McDonnell EJ. Congenital heart disease and scoliosis. J Pediatr 1968; 73: 725–733.Google Scholar
Shelton JE, Julian R, Walburgh E, Schneider E. Functional scoliosis as a long–term complication of surgical ligation for patent ductus arteriosus in premature infants. J Pediatr Surg 1986; 21: 855–857.Google Scholar
White RI Jr, Jordan CE, Fischer KC, Lampton L, Neil CA, Dorst JP. Skeletal changes associated with adolescent congenital heart disease. Am J Roentgenol Radium Ther Nucl Med 1972; 116: 531–538.Google Scholar
Reckles LN, Peterson HA, Weidman WH, Bianco AJ Jr. The association of scoliosis and congenital heart defects. J Bone Joint Surg Am 1975; 57: 449–455.Google Scholar
Jaureguizar E, Vazquez J, Murcia J, Diez Pardo JA. Morbid musculoskeletal sequelae of thoracotomy for tracheoesophageal fistula. J Pediatr Surg 1985; 20: 511–514.Google Scholar
Roth A, Rosenthal A, Hall JE, Mizel M. Scoliosis and congenital heart disease. Clin Orthop 1973; 93: 95–102.Google Scholar
Wright WD, Niebauer JJ. Congenital heart disease and scoliosis. J Bone Joint Surg Am 1956; 38: 1131–1136.Google Scholar
Weinstein SL. Adolescent idiopathic scoliosis – prevalence and natural history. In: Weinstein SL (ed.). The Pediatric Spine-Principles and Practice. Raven Press, New York, 1994, pp 463–478.
Kawakami N, Mimatsu K, Deguchi M, Kato F, Maki S. Scoliosis and congenital heart disease. Spine 1995; 20: 1252–1256.Google Scholar
Durning RP, Scoles PV, Fox OD. Scoliosis after thoracotomy in tracheoesophageal fistula patients. A follow-up study. J Bone Joint Surg Am 1980; 62: 1156–1159.Google Scholar
El Shafie M, Rickham PP. Long-term results after primary repair of esophageal atresia and tracheoesophageal fistula. Z Kinderchir 1971; 9: 309–316.Google Scholar
Freeman NV, Walkden J. Previously unreported shoulder deformity following right lateral thoracotomy for esophageal atresia. J Pediatr Surg 1969; 4: 627–636.Google Scholar
Alley RD. Thoracic surgical incisions and postoperative drainage. In: Cooper P (ed.). The Craft of Surgery, Vol I. Churchill Livingstone, London, 1964, pp 415–417.
Wiater JM, Flatow EL. Long thoracic nerve injury. Clin Orthop 1999; 368: 17–27.Google Scholar
Martin JT. Postoperative isolated dysfunction of the long thoracic nerve: a rare entity of uncertain etiology. Anesth Analg 1989; 69: 614–619.Google Scholar
Duralde XA. Evaluation and treatment of the winged scapula. J South Orthop Assoc 1995; 4: 38–52.Google Scholar
Seghaye M-C, Grabitz RG, Alzen G, et al. Thoracic sequelea after surgical closure of the patent ductus arteriosus in premature infants. Acta Paediatr 1997; 86: 213–216.Google Scholar