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Thoracic sequels after thoracotomies in children with congenital cardiac disease

Serpil Bal1, Huda Elshershari, Reyhan Celiker

  • 1Department of Physical Medicine & Rehabilitation, Hacettepe University, Ankara, Turkey.

Cardiology in the Young
|August 9, 2003
PubMed

Insights

Posterolateral thoracotomy in children for heart conditions frequently causes musculoskeletal deformities like scoliosis and shoulder asymmetry. Further research into muscle-sparing techniques is recommended to mitigate these long-term effects.

Area of Science:

  • Pediatric Surgery
  • Orthopedics
  • Cardiology

Background:

  • Posterolateral thoracotomy is the standard surgical approach for pediatric congenital heart disease.
  • This incision divides the latissimus dorsi and serratus anterior muscles, potentially impacting musculoskeletal development.

Purpose of the Study:

  • To investigate the incidence and types of musculoskeletal deformities in children following posterolateral thoracotomy for congenital cardiac disease.

Main Methods:

  • A cohort of 49 children (mean age 10.2 years) who underwent surgery for congenital heart disease via posterolateral thoracotomy was evaluated.
  • Musculoskeletal deformities were assessed, with a mean follow-up of 6 years post-surgery.

Main Results:

  • A high prevalence (94%) of various musculoskeletal deformities was observed.
  • Common deformities included shoulder elevation (61%), winged scapula (77%), thoracic wall asymmetry (14%), thoracic cage deformity (18%), and nipple asymmetry (63%).
  • Scoliosis was present in 31% of patients, with severe curves (>25 degrees) in only two.

Conclusions:

  • Musculoskeletal deformities are common sequelae of thoracotomy in pediatric patients with congenital heart disease.
  • Long-term follow-up until skeletal maturity is crucial for these patients.
  • Surgical techniques that preserve the serratus anterior and latissimus dorsi muscles should be prioritized, and interventional procedures may offer an alternative to minimize these adverse effects.

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