Cardiac Screening in Congenital Scoliosis

PURPOSE: Children with congenital scoliosis are known to have a high incidence of concomitant congenital heart disease. These cardiac conditions are generally easy to detect clinically. This paper will examine the utility of routine cardiac screening of asymptomatic children with congenital scoliosis for occult cardiac disease.

METHODS: One hundred and ninety consecutive children presenting to one institution with the diagnosis of congenital scoliosis without myelodysplasia or sacral agenesis were retrospectively reviewed. Twenty-four children (13%) had already been diagnosed with congenital heart disease upon presentation for their first evaluation by a spine surgeon. Sixty-four asymptomatic children were evaluated with an echocardiogram, while twenty-seven children were evaluated by a pediatrician or pediatric cardiologist for occult cardiac disease.

RESULTS: No child examined by a pediatrician or a pediatric cardiologist without echocardiogram was detected to have occult cardiac disease. One of the sixty-four children who underwent a screening echocardiogram was found to have a bicuspid aortic valve. This child’s cardiologist recommended antibiotic prophylaxis during spine surgery but no further cardiology follow-up was required.

CONCLUSIONS: Only one child with congenital scoliosis of the ninety-one screened (1%) was detected to have occult cardiac disease. This child was found to have a bicuspid aortic valve requiring no cardiac intervention. The incidence of 1% is consistent with the incidence of bicuspid aortic valve in the general population. Our findings do not support routine cardiac screening of children with congenital scoliosis beyond the usual history and physical examination.