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Published on: February 10, 2026
Operative treatment of scoliosis in patients with a Fontan circulation
Daniel J Hedequist1, John B Emans, John E Hall
1Orthopedic 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.
