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The purpose of this study was to evaluate the results of treatment in patients with deformities of the spine and congenital heart defects. Eighty-seven children aged 10 to 18 years old 27 males and 60 females were treated surgically due to scoliosis.

The deformity parameters were evaluated on the basis of the spine x-ray. In patients with combined and rigid forms of scoliosis, correction was performed using dorsal segmental instrumentation. Where there was rigid deformity and it was not possible to perform a front release according to the somatic indications, a one-stage dorsal correction was performed in conditions of halo traction in combination with SPO or Ponte osteotomy.

In patients with moderate impairment of blood circulation in the presence of rigid curvature of the main arch, two-stage surgery was performed, with ventral release at the apex of deformation, followed by halo traction.

As a second stage, dorsal correction and stabilization of the spine was performed. In the operated patients, the mean correction with dorsal instrumentation was An average of 12 vertebrae were included in fusion. Level of evidence IV, Case series. Nivel de Evidencia IV, Serie de casos. In modern practice, the number of patients presenting with scoliosis and congenital heart disease has increased. According to the literature, scoliosis is present in A right-sided thoracic arch is found in Therefore, children who have undergone heart surgery need a follow-up examination, conducted by specialists, for timely detection of the spine deformity.

In patients with idiopathic scoliosis who do not receive timely treatment, cardiopulmonary insufficiency may develop due to right ventricular overload. The high risk involved in intraoperative and early postoperative complications is often the reason for not performing surgical correction of the spinal deformity.

The aim of the work: To evaluate the results of treatment in patients with spinal deformities and heart defects. Eighty-seven children aged 10 to 18 years mean age There were 27 males and 60 females. Congenital scoliosis was found in of the 30 children; idiopathic in 52, secondary scoliosis after heart surgery in 5. Patients underwent dorsal correction of the spinal deformity.

The ring halo was fitted in 60 patients, with single-stage dorsal correction in 32, two-stage correction in 42, and Smith-Peterson SPO or Ponte osteotomy in 13 patients.

Eighty out of the 87 children had cardiovascular failure circulatory deficiency st degree. Among these children, the following heart defects were identified: the only ventricle three-chambered heart in 1 case, open arterial duct in 2 cases, defects of the interatrial septum in 4 cases, interventricular septum defects in 4 cases, mitral valve stenosis in 1 case, valvular heart disease in 27 cases, mitral valve prolapse in 14 cases, mitral valve insufficiency in 3 cases, mitral valve deficiency in combination with tricuspid insufficiency in 5 cases, with aortic insufficiency in 3 cases, and with pulmonary valve stenosis in 2 cases.

Cardiomyopathy was diagnosed in 5 children. In addition, we observed 5 patients who had undergone heart surgery: 1 for pulmonary artery stenosis, 1 for open arterial duct, 2 for interventricular septum defect, 1after radical correction of the double ventricular vascular withdrawal from the right ventricle, plasty of the interventricular defect septa, and elimination of pulmonary artery stenosis.

The surgical was performed on patients with grade IV scoliosis according to Chaklin's classification in the presence of hemodynamically compensated defects of the cardiovascular system.

The severity of the disease was assessed, taking into account the degree of curvature of the spine and the patient's somatic status. To determine the mobility of the deformity, functional tests - bending tests and a traction test - were carried out. Mobile deformities were recorded in 48 children, rigid ones in Thoracic scoliosis was found in 23 cases, lumbar scoliosis in 17, and combined scoliosis in Respiration function was evaluated with spirography, and electrocardiography and echocardiography were also performed.

Patients were seen by a cardiologist. MHOAP The first classification determines the patient's initial physical status, while the second also takes into account the nature of the surgical intervention. In patients with combined and rigid forms of scoliosis, the correction was performed using dorsal segmental instrumentation.

In cases of rigid deformity and inability to perform a front release according to the somatic indications, a one-stage dorsal correction was performed in conditions of halo traction in combination with SPO or Ponte osteotomy. After applying the halo ring, dorsal access was established with transpedicular screws, then resection of the spinous processes was performed on the segments selected for posterior osteotomy.

With the help of Kerrison's pistol clippers, the yellow ligament and arches were resected on the right and left sides. To stem the bleeding from the epidural vessels and damaged bone, a collagen haemostatic sponge and wax were used.

If there was a high risk of complications, dorsal stabilization of the spine with moderate correction was performed. In order to reduce the risks of intraoperative and postoperative complications and shorten the surgery time, a segmental dorsal hook instrumentation was used in combination with the intraoperative halotraction.

In patients with moderate impairment of blood circulation in the presence of rigid curvature of the main arch, two-stage operative treatment was performed. The first stage was performed by thoracotomy, ventral release at the apex of deformation, and assembly of the halo ring.

Dorsal correction was performed as a second stage, after wound healing and recovery, as well as stabilization of the spine using segmental instruments of screw, hook and hybrid equipment. The study was approved by the N. All participants signed an Informed Consent Form prior to enrolling in the study. All authors declare no potential conflict of interest related to this article. Anesthesia principles in the surgical treatment of scoliosis in children with heart defects.

Principles of anesthesia for scoliosis surgery in children are associated with the vastness of the operating field and high traumatism, significant blood loss, and the presence of concomitant pathology in the form of circulatory disorders and respiratory failure.

The first two factors are related to the surgical side of the problem, but the anesthesiologist should consider them when in the choice of anesthetic strategy. Prevention of complications associated with concomitant pathology is entirely the prerogative of the anesthesiologist.

Operational risk on the ASA scale in the majority First to third-degree respiratory failure was noted in all 87 patients: restrictive type in 47 patients, obstructive in 14, and mixed in Therefore, to prevent respiratory complications, it was important to ensure that the patients were breathing spontaneously after surgery, and in a state of complete decurarization.

Also adequate analgesia of the operating wound was required; this was achieved due to epidural analgesia with 0. Adequate analgesia enables the patient to perform breathing exercises and provokes a cough. It ensures the active position of the child in bed, and reduces postoperative nausea and vomiting.

Transthoracic release of the intervertebral structures and dorsal correction of scoliosis was performed under general multicomponent anesthesia, with sevoflurane as the main anesthetic, and bolus injection of fentanyl against a background of artificial ventilation and postoperative parenteral analgesia with promedol in combination with NSAIDs. In 45 children, dorsal correction of scoliosis involved lumbar epidural analgesia with morphine and anesthesia-assisted sevoflurane in subanesthetic doses, with artificial ventilation.

Postoperative analgesia was provided by epidural analgesia with ropivacaine in combination with NSAIDs. A year-old patient was admitted to hospital with combined IV grade scoliosis of the thoracolumbar spine.

Anamnestic data: child from the 3rd pregnancy, which took place physiologically, the birth is 3rd, on time. Birth weight was grams, height 53 cm. In , the child underwent surgical treatment at the Bakulev National Medical Research Center of Cardiovascular Surgery, where he underwent radical correction of the defect of double separation of the main vessels from the right ventricle. Deformation of the spine was detected at an early age, progressing from 5 years. The child was observed at home, by an orthopedist.

Conservative treatment with courses was conducted, without positive dynamics. Surgery was recommended. Orthopedic status at admission to the hospital: the child received no additional assistance, the trunk is asymmetrical, the head is shifted to the left of the median line, the thorax is deformed, with a gently curving rib hump on the right, the right shoulder-line is 7 cm above the left, the nipples are equidistant from the midline, on one level, the triangles of the waist are asymmetric, the navel is in the midline, skewing of the pelvis is not present when viewed from the side, cervical lordosis is increased, thoracic kyphosis is increased, lumbar lordosis is enlarged.

When viewed from behind: the spine axis is dislocated. Scoliotic curvature of the thoracic, lumbar spine is present. The angles of the scapulae are asymmetric. The intergluteal fold is shifted to the left of the plumb line by 3 cm Figure 1 A, B, B.

The lower limbs are equal in length. Range of movement in the large and small joints of the upper and lower extremities is complete and unrestricted. The arches of the feet are formed by age. With magnetic resonance imaging, the spinal cord pathology is not revealed. ECG: sinus rhythm, heart rate per 1 minute, normal position of the electrical axis of the heart. The child was consulted by a cardiologist at the Bakulev centre.

Conclusion: congenital heart disease: a double vascular leakage from the right ventricle, and interventricular septum defect. The condition after the operation of radical correction of double vascular withdrawal from the right ventricle, plastic defect of the interventricular septum, and elimination of stenosis of the pulmonary artery There are no contraindications for prompt correction of scoliosis.

In consultation with a geneticist, a hereditary pathology was established: frontal metaphyseal dysplasia with a recessive X-linked type of inheritance. OMIM: Skeletal abnormalities are described: scoliosis, funnel-shaped and keel-like deformity of the chest, X-ray examination revealed diffuse hyperostosis of the skull, especially in the frontal part. The patient underwent two-stage surgical treatment.

The first step was the application of the halo ring. In order to mobilize the spine deformity, a halo brace was performed in the orthopedic chair. The somatic state was stable.

There were no hemodynamic disturbances from the cardiovascular system. The second stage was the surgery itself: Dorsal correction of scoliosis, and stabilization of the spine by instrumentation at levels Th1-L5.

The operation lasted 2 hours 35 minutes, the anesthesia lasted 3 hours 40 minutes. The patient spent the first 24 hours after the operation in the intensive care unit.

He was transferred to the police department on the second day after the operation. In the first week of the postoperative period, complaints of a periodic feeling of heat, and a rapid heart rate were noted.

In the control ECG: complete blockade of the right leg of the His bundle. Signs of myocardial hypoxia: QT lengthening of 0. The child was seen by a cardiologist.



Posterior thoracotomy: a two-step spinal thoracic approach. Hospital Nacional de Pediatria Prof. Profesor J. Garrahan - Buenos Aires, Argentina. Nivel superior T3 e inferior T Objective: to assess the range of possibilities and complications associated with this new approach, which allows to mix a two-step surgery through a single posterior skin incision. All patients underwent a two-step approach through a single posterior mid-line skin incision for spinal cord decompression, discectomy, arthrodesis, osteotomy, or vertebrectomy.


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