Routine Preoperative Echocardiograms in Select Patients with Adolescent Idiopathic Scoliosis Rarely Show Abnormalities and do not Predict Adverse Cardiovascular Events

Abstract

Study Design: Retrospective Objectives: The prevalence and clinical significance of cardiac abnormalities detected on ECHO in surgically treated AIS patients is unclear. Our goals were to determine the prevalence of cardiac abnormalities detected on echocardiography (ECHO) in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). Further, we aimed to determine whether preoperative curve magnitude is associated with abnormal ECHO findings and whether ECHO abnormalities are associated with perioperative cardiovascular complications. Methods:We reviewed clinical records of 619 patients aged 10 to 18 years with AIS who underwent spinal fusion from 2000 through 2015. Indications for ECHO were a major curve greater than 70º or recommendation by primary care providers. Major curve magnitudes were calculated using Cobb angles. We assessed for adverse perioperative cardiovascular events. Statistical significance was tested using Student t test with an alpha level of <.05.Results: Forty-three (7 %) patients had a preoperative ECHO within 6 months before surgery (23 normal ECHOs, 16 normal variants (including trivial valvular abnormalities), and 4 abnormal ECHOs (all mild functional or structural abnormalities). There was no association between presence of cardiac abnormalities and major curve magnitude (p = .38). There were no documented perioperative adverse cardiovascular events in any of the 43 cases nor in the 576 patients who did not have preoperative ECHOs. Conclusion:Patients with abnormal ECHOs did not experience perioperative cardiovascular events. Curve magnitude was not associated with abnormal ECHO findings. Routine preoperative ECHOs in AIS patients based on curve magnitude did not change management in these patients.