Role of Preoperative Cardiac Screening Studies in Adolescent Idiopathic Scoliosis Surgery: Paper #15

Widmann, Roger F. MD; Flynn, Patrick A. MD; Chan, Gilbert; Kozich, Jeanine M. MD; Boachie‐Adjei, Oheneba MD; Blanco, John S. MD; Green, Daniel W. MS, MD, FACS; Ipp, Lisa S. MD

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Summary: The prevalence of asymptomatic cardiac disease in adolescents with idiopathic scoliosis(AIS)has not been well documented. We have identified significant cardiac findings in our cohort of asymptomatic patients with severe AIS presenting for surgery. We were particularly interested in the novel findings of aortic root and valve abnormalities which are not present in the randomly selected, healthy adolescent patient.

Introduction: We sought to evaluate the incidence of occult cardiac disease in the severe AIS patient by reviewing the echocardiograms and EKGs performed at their pre‐operative evaluation for spinal fusion.

Methods: Retrospective chart review of all surgical AIS patients from 2000‐2007 was completed. Demographic information including age at surgery, sex, curve magnitude, fusion type, instrumentation, and surgical course was compiled. Patients with neuromuscular scoliosis or known/suspected cardiac disease were excluded. Pre‐surgical screening 12 lead EKG, 2D‐Doppler and M‐mode echocardiograms were analyzed.

Charts of 215 pre‐operative AIS patients were reviewed. 3 patients were excluded because the studies were not ordered. All patients were examined by a pediatrician and had normal cardiac examinations.

Results: 212 subjects (age 12‐18) 154(73%) female, and 58(27%) male. 141(67%) had normal EKGs and echocardiograms. In 32(15%) subjects with EKG abnormalities, 28(88%) had normal variant readings, as outlined by the AHA statement on screening EKGs in ADHD patients (Vetter) and 4 subjects’EKGs met LVH by voltage criteria. However, echocardiograms were within normal limits in these patients.

Significant echocardiogram findings (table 1) revealed 2(0.94%) subjects with atrial septal defects (that delayed surgery) and 7(3.3%) subjects with aortic root/valve abnormalities.

Conclusion: In our cohort of pre‐operative AIS patients, cardiac abnormalities ranged from mild to severe, and in 2 cases, affected the sugical timing. Novel findings of aortic abnormalities were identified in 3.3% of patients. Interestingly, the incidence of mitral valve prolapse was only 4.7% which is lower than described in prior studies, (14%‐26%), and closer to the rate in the general population (3.2%)(Dhuper).

In a study which examined the prevalence of heart disease in randomly selected healthy adolescents with previously unknown cardiac disease (Steinberger), there was a rate of 3.6%(13/357) of cardiac anomalies. Of note, none had aortic root/valve findings.

Significance: The aortic root/valve abnormalities appear to be unique findings in patients with severe AIS, and suggest a possible collagen vascular component in this disease. Echocardiograms may be indicated in patients with AIS.

© 2010 Lippincott Williams & Wilkins, Inc.