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Lieu B, Crawford E, Laubach L, Yeramosu T, Sharps C, Horstmann J, Kuester V. Patient education strategies in pediatric orthopaedics: using ChatGPT to answer frequently asked questions on scoliosis. Spine Deform 2025:10.1007/s43390-025-01087-y. [PMID: 40186826 DOI: 10.1007/s43390-025-01087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 03/20/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE Patients increasingly rely on online resources to better understand their health conditions. ChatGPT could satisfy the demand for reliable and accessible online health education resources, yet few studies have applied this to pediatric orthopaedic counseling. This study quantifies the accuracy and comprehensibility of ChatGPT responses to frequently asked questions (FAQs) regarding scoliosis. METHODS Twelve FAQs regarding scoliosis were compiled following a literature review, and ChatGPT Version 3.5 was utilized to answer them. The responses were analyzed for accuracy and clarity using the Mika et al. scoring system and modified DISCERN score in collaboration with two fellowship-trained pediatric orthopaedic surgeons. Readability was assessed using several published educational-level indices. RESULTS The ChatGPT responses received a Mika et al. average of 2.4 (satisfactory requiring minimal to moderate clarification) and an averaged mean DISCERN score of 45.9. The estimated reading level necessary for comprehension ranged from 11th grade to college graduate. CONCLUSIONS When prompted with 12 scoliosis FAQs, ChatGPT produces responses of satisfactory accuracy but require further clarification and are written at an inappropriately high reading level for the scoliosis patient population. Future research should explore strategies to verify the reliability of AI services for counseling on other pediatric orthopaedic conditions.
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Affiliation(s)
- Brigitte Lieu
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA, 23298, USA.
| | - Ethan Crawford
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA, 23298, USA
| | - Logan Laubach
- UCSF Fresno Department of Orthopaedic Surgery, 155 N. Fresno St., Fresno, CA, 93701 - 2302, USA
| | - Teja Yeramosu
- Rothman Orthopaedic Institute at Adventhealth Orlando, 601 E Rollins St., Orlando, FL, 32803, USA
| | - Chester Sharps
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA, 23298, USA
| | - Joanna Horstmann
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA, 23298, USA
| | - Victoria Kuester
- VCU Health Department of Orthopaedic Surgery, PO Box 980153, Richmond, VA, 23298, USA
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Liu C, Tan K, Huang X, Wang S, Yu B, Xiong F. Improvement of Cardiac and Pulmonary Function in Patients With Moderate-to-Severe Idiopathic Scoliosis After Posterior Corrective surgery-A Single-Center, Prospective Cohort Study. Global Spine J 2025:21925682251320334. [PMID: 39964770 PMCID: PMC11836968 DOI: 10.1177/21925682251320334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/31/2024] [Accepted: 01/29/2025] [Indexed: 02/20/2025] Open
Abstract
STUDY DESIGN Prospective single-center cohort study. OBJECTIVE To evaluate cardiac morphology, cardiac function, and pulmonary hypertension impairment in patients with idiopathic scoliosis (IS) and their changes one year after scoliosis surgery. METHODS 70 patients with IS with predominantly thoracic curvature Cobb angle >40° were enrolled and categorized into moderate (<70°) and severe (≥70°) groups. Preoperative radiography and transthoracic echocardiography were performed. Postoperatively, 51 patients completed a one-year follow-up and were compared with preoperative data. RESULTS (1) Left ventricular end-diastolic diameter (LVEDD), left ventricular global longitudinal strain (LVGLS), and e were lower and E/e was higher in the moderate vs severe group, and the aortic internal diameter and LVEF were lower in the severe group than in the control group (P < 0.05); (2) Right ventricular free wall strain (RVFWS), tricuspid annular plane systolic excursion (TAPSE), and TAPSE/systolic pulmonary artery pressure (SPAP) were lower, and SPAP was higher in the moderate vs severe group than in the control group (P < 0.05); (3) The thoracic curve Cobb angle was significantly negatively correlated with LVEDD, SV, LVGLS, RVFWS, TAPSE, TAPSE/SPAP and FVC and FEV1 measured/predicted (P < 0.05), and positively correlated with SPAP (P < 0.05); (4) After one-year postoperative follow-up, LVEDD, LVGLS, SV, e, RVFWS, TAPSE and TAPSE/SPAP were higher, and E/e and SPAP were lower (P < 0.05) compared to pre-operation. CONCLUSION Cardiac morphology, left and right heart function, and pulmonary function were impaired in patients with IS, and which showed significant improvement after posterior corrective surgery.
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Affiliation(s)
- Chunxia Liu
- Department of Cardiology, Cardiovascular Institute of Chengdu, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Kunyue Tan
- Department of Cardiology, Cardiovascular Institute of Chengdu, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Xiaofeng Huang
- Department of Cardiology, Cardiovascular Institute of Chengdu, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Shuzhen Wang
- Department of Cardiology, Cardiovascular Institute of Chengdu, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Bin Yu
- Department of Orthopedics, The Third People’s Hospital of Chengdu, Chengdu, China
| | - Feng Xiong
- Department of Cardiology, Cardiovascular Institute of Chengdu, The Third People’s Hospital of Chengdu, Chengdu, China
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Sonaglioni A, Nicolosi GL, Lombardo M. The relationship between mitral valve prolapse and thoracic skeletal abnormalities in clinical practice: a systematic review. J Cardiovasc Med (Hagerstown) 2024; 25:353-363. [PMID: 38526955 DOI: 10.2459/jcm.0000000000001614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Literature data suggest high inter-study variability in mitral valve prolapse (MVP) prevalence among individuals with thoracic skeletal abnormalities (TSA). This systematic review aimed at estimating the overall prevalence of MVP in individuals with the most common TSA, including not only the oldest studies (before the year 2000) but also the most recent ones (after the year 2000). METHODS PubMed and EMBASE databases were systematically reviewed in November 2023. Studies assessing the relationship between MVP and TSA and estimating the MVP prevalence in pectus excavatum (PE), pectus carinatum (PC), scoliosis, straight back syndrome (SBS) and Marfan syndrome (MS) were included. There was no limitation on time periods. RESULTS Twenty-five studies with a total of 2800 patients (27.9 ± 13.9 years, 48.2% females) were analyzed. The highest prevalence of MVP was observed among MS patients (47.3%), while the lowest was detected in PC individuals (23%). Prevalence of MVP was similar among PE (30.8%), scoliosis (26.3%) and SBS (25.5%) patients. When dividing the studies on the basis of temporal period, the average MVP prevalence was approximately two-fold higher in all studies conducted before the year 2000 in comparison with the most recent ones, regardless of TSA type. This discrepancy might be primarily ascribed to relevant differences in the echocardiographic criteria employed for MVP diagnosis before (less specific) and after (more specific) the year 2000, respectively. CONCLUSIONS The estimated MVP prevalence in TSA individuals is significantly higher than that observed in the general population. Individuals with TSA should be screened for MVP presence on transthoracic echocardiography.
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Bas JL, Pérez S, Rubio P, Mariscal G, Bonilla F, Bovea M, Bas P, Bas T. Incidence of cardiac anomalies in congenital vertebral deformity: systematic review and meta-analysis of 2910 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2967-2974. [PMID: 37294359 DOI: 10.1007/s00586-023-07817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 03/26/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This study aimed to analyze the overall incidence of cardiac abnormalities in patients with congenital scoliosis and the possible influencing factors. METHODS PubMed, Embase, and Cochrane Library were searched for relevant studies. The quality of the studies was assessed independently by two authors using the methodological index for nonrandomized studies (MINORS) criteria. The following data were extracted from the included studies: bibliometric data, number of patients, number of patients with cardiac anomalies, gender, types of deformity, diagnostic method, type of cardiac anomaly, location, and other associated anomalies. The Review Manager 5.4 software was used to group and analyze all the extracted data. RESULTS This meta-analysis included nine studies and identified that 487 of 2,910 patients with congenital vertebral deformity had cardiac anomalies diagnosed by ultrasound (21.05%, 95% CI of 16.85-25.25%). The mitral valve prolapse was the most frequent cardiac anomaly (48.45%) followed by an unspecified valvular anomaly (39.81) and an atrial septal defect (29.98). A diagnosis of cardiac anomalies was highest in Europe (28.93%), followed by USA (27.21%) and China (15.33%). Females and formation defects were factors significantly associated with increased incidence of cardiac anomalies: 57.37%, 95% CI of 50.48-64.27% and 40.76%, 95% CI of 28.63-52.89%, respectively. Finally, 27.11% presented associated intramedullary anomalies. CONCLUSIONS This meta-analysis revealed that the overall incidence of cardiac abnormalities detected in patients with congenital vertebral deformity was 22.56%. The incidence rate of cardiac anomalies was higher in females and those with formation defects. The study offers guidance for ultrasound practitioners to accurately identify and diagnose the most common cardiac anomalies.
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Affiliation(s)
- Jose Luis Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Silvia Pérez
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pedro Rubio
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Gonzalo Mariscal
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain.
| | - Fernando Bonilla
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miquel Bovea
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Paloma Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Teresa Bas
- Spine Unit, Department of Orthopedic Surgery and Traumatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Abstract
STUDY DESIGN Single-center retrospective chart review with minimum 2-year follow up. OBJECTIVE To determine incidence of pulmonary hypertension in adolescent idiopathic scoliosis patients and to determine the effect of scoliosis surgery on pulmonary hypertension. SUMMARY OF BACKGROUND DATA Spinal deformity in adolescent idiopathic scoliosis can increase right atrial and ventricular pressures secondary to restrictive lung disease. Pulmonary hypertension leading to cor pulmonale is the most feared outcome, however mild pulmonary hypertension in adolescent idiopathic scoliosis (AIS) patients has been reported. No study has previously examined changes in the improvement of right heart function following scoliosis surgery. METHODS Cobb angle, 2D-echo signs of structural heart disease, aortic root dimensions, tricuspid regurgitant jet velocity (TRV), pulmonary function tests (PFTs), arterial blood gas (ABG), and patient demographics reviewed. Right ventricular systolic pressure (RVSP) estimated using Bernoulli equation (4[TRV]2) and right atrial pressure. RVSP ≥36 mmHg is a surrogate marker for pulmonary hypertension. All echocardiograms were read by board certified Pediatric Cardiologists. Logistic regression used to assess for differences in TRV between groups. RESULTS Mean preoperative RVSP was significantly elevated in AIS patients (26.9 ± 0.49; P < 0.001) compared with controls (17.25 + 0.88). Only 47 (21%) Group 1 patients had elevated preoperative TRV (≥2.8 m/s) versus none in Group 2 (P < 0.001). Additionally, logistic regression showed AIS patients have odds ratio of 3.29 for elevated TRV (P = 0.007)-an indirect measure of pulmonary hypertension. In all Group 3 patients, the cardiac function normalized postoperatively (mean TRV = 2.09 + 0.23; P < 0.001). No association found between Cobb angle, aortic root parameters, or pulmonary function tests. CONCLUSION This study found 13.9% of patients with adolescent idiopathic scoliosis had elevated TRV while controls had no TRV abnormalities. Additionally, RVSP measurements demonstrated mild pulmonary hypertension in AIS patients. These abnormal values normalized postoperatively, indicating the benefits of scoliosis surgery on cardiac function in adolescent idiopathic scoliosis.Level of Evidence: 3.
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Lang C, Wang R, Chen Z, He S, Zou Q, Wu J, Zhu X. Incidence and Risk Factors of Cardiac Abnormalities in Patients with Idiopathic Scoliosis. World Neurosurg 2019; 125:e824-e828. [PMID: 30738943 DOI: 10.1016/j.wneu.2019.01.177] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We sought to investigate the incidence of cardiac abnormalities in patients with idiopathic scoliosis and identify risk factors related to cardiac abnormalities. METHODS A cohort of 531 patients with idiopathic scoliosis requiring surgical treatment in our hospital from March 2009 to August 2017 were recorded. Clinical data including medical records, radiograph, and echocardiogram were collected. All patients were divided into groups: control, congenital heart disease (CHD), and other cardiac abnormalities (OCAs). The incidence and related factors for cardiac abnormalities were analyzed. RESULTS The age of the study cohort was 17.8 ± 7.3 years. The average Cobb angle was 57.7 ± 16.5 degrees. Cardiac abnormalities were found in 149 (28.06%) patients, including 22 (4.14%) with CHD and 127 (23.92%) with OCAs. Atrial septal defect was the most common CHD with an incidence of 1.13% (6 of 531). Mitral valve prolapse was detected in 62 (11.68%) patients, which was the most prevalent OCA. Patients with CHD or OCAs weighed less as compared with patients without cardiac abnormalities. Low height was associated with CHD in patients with idiopathic scoliosis. Six patients with severe cardiac abnormalities must undergo cardiac intervention before scoliosis surgery. CONCLUSIONS The overall incidence of cardiac abnormalities was 28.81% in patients with idiopathic scoliosis. An echocardiogram may be helpful as a preoperative examination for patients with idiopathic scoliosis before scoliosis surgery.
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Affiliation(s)
- Chuandong Lang
- Department of Orthopaedics Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruijun Wang
- Department of Surgery, Beijing Changping Hospital, Beijing, China
| | - Ziming Chen
- Shantou University Medical College, Shantou, Guangdong, China
| | - Shaofu He
- Department of Radiation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qihua Zou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Jinna Wu
- Department of Oncology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Xiaojun Zhu
- Department of Musculoskeletal Oncology, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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Saito W, Inoue G, Imura T, Nakazawa T, Miyagi M, Shirasawa E, Kuroda A, Uchida K, Takaso M. The Relationship between Preoperative Echocardiographic Evaluation and Spinal Deformity in Patients with Neuromuscular Scoliosis. Spine Surg Relat Res 2018; 2:48-52. [PMID: 31440646 PMCID: PMC6698548 DOI: 10.22603/ssrr.2017-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/21/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Echocardiography is an important component of perioperative cardiac risk stratification in patients with neuromuscular scoliosis (NMS). However, there are little data regarding the relationship between preoperative echocardiographic findings and spinal deformity. We retrospectively reviewed preoperative echocardiographic data to investigate the relationship between echocardiographic evaluation and spinal deformity in NMS. Methods We reviewed 73 NMS patients (mean age: 13.3 years, male 66%) who underwent spinal correction surgery between 2008 and 2016. Echocardiographic data including ejection fraction (EF), valvar disease, and inferior vena cava diameter were collected from the preoperative exam. Demographic and radiographic data were also collected. Results Preoperative diagnoses included Duchenne muscular dystrophy, Fukuyama congenital muscular dystrophy, other dystrophy, spinal muscular atrophy, and congenital myopathies. Mean Body Mass Index (BMI) was 15.6 kg/m2. Mean major Cobb angle before surgery was 86.6 ± 28.2°. Because of technical difficulty, complete echocardiographic data could only be collected and evaluated in 49.3% of patients. Neither right nor left sided cardiac evaluation could be completed in 20.5%. Patients in whom complete echocardiographic data could not be collected had significantly more extensive thoracic scoliosis with a more rigid curve and hypokyphosis, and were of lower weight and BMI than patients in whom complete data could be collected. Ten cases (13.7%) were diagnosed as having minor heart-related complications immediately after surgery, and they had higher right atrial pressures preoperatively. Conclusions Echocardiography can be technically difficult in NMS patients with extensive spinal deformities. We found that perioperative cardiac function could only be evaluated by echocardiogram in about half of NMS patients undergoing spinal correction surgery. The absence of an adequate preoperative cardiac evaluation could render these patients more susceptible to perioperative heart-related complications. Echocardiography may not be sufficient to evaluate cardiac conditions in children with extensive NMS.
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Affiliation(s)
- Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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A Retrospective Study of Congenital Cardiac Abnormality Associated with Scoliosis. Asian Spine J 2016; 10:226-30. [PMID: 27114761 PMCID: PMC4843057 DOI: 10.4184/asj.2016.10.2.226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 07/24/2015] [Accepted: 08/01/2015] [Indexed: 11/24/2022] Open
Abstract
Study Design Retrospective study. Purpose To identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment
for scoliosis. Overview of Literature Congenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent
surgical treatment for scoliosis. Methods Ninety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female [51%]) and IS (35 patients, 21 female [60%]). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed. Results We found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients). Conclusions We determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups.
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DiCindio S, Arai L, McCulloch M, Sadacharam K, Shah SA, Gabos P, Dabney K, Theroux MC. Clinical relevance of echocardiogram in patients with cerebral palsy undergoing posterior spinal fusion. Paediatr Anaesth 2015; 25:840-845. [PMID: 25958933 DOI: 10.1111/pan.12676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spinal deformity is one of the secondary musculoskeletal problems that occur with cerebral palsy (CP). Of the co morbidities associated with CP and spinal deformity, cardiac function is of theoretical concern. OBJECTIVE The goal of our study was to determine the clinical relevance of routine preoperative cardiology evaluation via echocardiogram for patients with CP presenting for posterior spine fusion (PSF) surgery. METHODS A retrospective chart review was performed of CP patients presenting for scoliosis surgery. The data collected for each patient included: age, sex, height, weight, Cobb angle, and medical history. All patients had a preoperative cardiac evaluation. RESULTS Seventy-two patients were included. The mean age was 13.6 ± 3.4 years. Left ventricular systolic function was normal in all patients; the mean shortening fraction was 39.3 ± 6.2%. No patient had more than mild insufficiency of either the semilunar or atrioventricular valve. One patient was diagnosed with aortic root dilation as well as aortic valve insufficiency. All patients had PSF surgery without changes in anesthetic or surgical plans, and no patient experienced complications attributable to a cardiac origin. CONCLUSION The results suggest that routine preoperative cardiology evaluation via echocardiogram for children with CP in the absence of clinical history or physical examination findings suggestive of cardiac disease is not necessary.
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Affiliation(s)
- Sabina DiCindio
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lynda Arai
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael McCulloch
- Department of Cardiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kesavan Sadacharam
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Suken A Shah
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Orthopedics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Peter Gabos
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Orthopedics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kirk Dabney
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Orthopedics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mary C Theroux
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Huh S, Eun LY, Kim NK, Jung JW, Choi JY, Kim HS. Cardiopulmonary function and scoliosis severity in idiopathic scoliosis children. KOREAN JOURNAL OF PEDIATRICS 2015. [PMID: 26213550 PMCID: PMC4510355 DOI: 10.3345/kjp.2015.58.6.218] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Idiopathic scoliosis is a structural lateral curvature of the spine of unknown etiology. The relationship between degree of spine curvature and cardiopulmonary function has not yet been investigated. The purpose of this study was to determine the association between scoliosis and cardiopulmonary characteristics. METHODS Ninety children who underwent preoperative pulmonary or cardiac evaluation at a single spine institution over 41 months were included. They were divided into the thoracic-dominant scoliosis (group A, n=78) and lumbar-dominant scoliosis (group B, n=12) groups. Scoliosis severity was evaluated using the Cobb method. In each group, relationships between Cobb angles and cardiopulmonary markers such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, left ventricular ejection fraction, pulmonary artery flow velocity, and tissue Doppler velocities (E/E', E'/A') were analyzed by correlation analysis linear regression. RESULTS In group A, 72 patients (92.3%) underwent pulmonary function tests (PFTs), and 41 (52.6%) underwent echocardiography. In group B, 9 patients (75.0%) underwent PFT and 8 (66.7%) underwent echocardiography. Cobb angles showed a significant negative correlation with FVC and FEV1 in group A (both P<0.05), but no such correlation in group B, and a significant negative correlation with mitral E/A ratio (P<0.05) and tissue Doppler E'/A' (P<0.05) in group A, with a positive correlation with mitral E/A ratio (P<0.05) in group B. CONCLUSION Pulmonary and cardiac function was significantly correlated with the degree of scoliosis in patients with thoracic-dominant scoliosis. Myocardial diastolic function might be impaired in patients with the most severe scoliosis.
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Affiliation(s)
- Seokwon Huh
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Lucy Yougmin Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyun Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jo Won Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Sun Kim
- Division of Spine, Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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Renna MD, Pisani P, Conversano F, Perrone E, Casciaro E, Renzo GCD, Paola MD, Perrone A, Casciaro S. Sonographic markers for early diagnosis of fetal malformations. World J Radiol 2013; 5:356-371. [PMID: 24179631 PMCID: PMC3812447 DOI: 10.4329/wjr.v5.i10.356] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/10/2013] [Accepted: 09/18/2013] [Indexed: 02/06/2023] Open
Abstract
Fetal malformations are very frequent in industrialized countries. Although advanced maternal age may affect pregnancy outcome adversely, 80%-90% of fetal malformations occur in the absence of a specific risk factor for parents. The only effective approach for prenatal screening is currently represented by an ultrasound scan. However, ultrasound methods present two important limitations: the substantial absence of quantitative parameters and the dependence on the sonographer experience. In recent years, together with the improvement in transducer technology, quantitative and objective sonographic markers highly predictive of fetal malformations have been developed. These markers can be detected at early gestation (11-14 wk) and generally are not pathological in themselves but have an increased incidence in abnormal fetuses. Thus, prenatal ultrasonography during the second trimester of gestation provides a “genetic sonogram”, including, for instance, nuchal translucency, short humeral length, echogenic bowel, echogenic intracardiac focus and choroid plexus cyst, that is used to identify morphological features of fetal Down’s syndrome with a potential sensitivity of more than 90%. Other specific and sensitive markers can be seen in the case of cardiac defects and skeletal anomalies. In the future, sonographic markers could limit even more the use of invasive and dangerous techniques of prenatal diagnosis (amniocentesis, etc.).
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Abstract
INTRODUCTION We sought to evaluate findings of screening cardiac studies in adolescent idiopathic scoliosis (AIS) patients by reviewing the echocardiograms and electrocardiograms (EKGs) performed at their preoperative evaluation for spinal fusion. METHODS Retrospective chart review of all surgical AIS patients from 2000 to 2007 was completed (n=212). Patients with neuromuscular scoliosis, known connective tissue disease, or known/suspected cardiac disease were excluded. In presurgical screening, 12 lead EKG, 2dimensional-Doppler, and M-mode echocardiograms were analyzed. RESULTS A total of 154 (73%) female and 58 (27%) male patients (aged 12 to 18 y, avg: 14.8 y) were analyzed. EKG findings, 180/212 (85%), were within normal limits. Twenty-eight of 212 (13%) patients were found to have normal variant readings. Four of 212 (2%) patients met criteria for left ventricular hypertrophy on EKG, but were subsequently found to have normal echocardiograms. Significant echocardiogram findings revealed 2 (0.94%) subjects with atrial septal defects (ASDs) (that delayed surgery) and 7 (3.3%) subjects with aortic root/valve abnormalities. CONCLUSIONS In our cohort of preoperative AIS patients, cardiac abnormalities ranged from mild to severe, and in 2 cases, affected the surgical timing. Novel findings of aortic abnormalities were identified in 3.3% of patients. In a study which examined the prevalence of heart disease in randomly selected healthy adolescents with previously unknown cardiac disease (Steinberger), there was a rate of 3.6% (13/357) of cardiac anomalies. Of note, only 0.6% had aortic root/valve findings. The results of our retrospective review indicate that EKG does not provide significant information compared with echocardiogram as part of the preoperative evaluation of asymptomatic and otherwise healthy patients with AIS who are undergoing spinal deformity surgery. However, use of the echocardiogram may be appropriate for the diagnosis of previously unknown cardiac abnormalities in this population, as aortic root/valve abnormalities seem to be unique findings in these patients. LEVEL OF EVIDENCE Level IV, Retrospective, descriptive case series.
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Liu YT, Guo LL, Tian Z, Zhu WL, Yu B, Zhang SY, Qiu GX. A retrospective study of congenital scoliosis and associated cardiac and intraspinal abnormities in a Chinese population. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:2111-4. [PMID: 21533853 DOI: 10.1007/s00586-011-1818-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/07/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
Our objective is to assess the incidence of cardiac and intraspinal abnormities in Chinese congenital scoliosis (CS) patients and to study the relationship between the associated abnormities and the different CS types. Five-hundred and thirty-nine consecutive Chinese patients with CS were retrospectively studied, and the records of echocardiography, plain radiograph of the entire spine, magnetic resonance imaging of the entire spine and/or myelogram were reviewed. The results indicated that the incidence of cardiac and intraspinal abnormities in CS patients was 14.1 and 24.5%, respectively. There was no difference in the incidence of associated cardiac and intraspinal abnormities in different CS types (P > 0.05). The most common cardiac abnormities in CS patients was mitral valve prolapse, which was followed by congenital heart diseases, including atrial septal defect, ventricular septal defect, bicuspid aortic valve and patent ductus ateriosus. The cardiac abnormities were not likely to be concurrent with intraspinal abnormities in CS patients (P = 0.04). The intraspinal abnormities were more common in female and older patients (all P < 0.05). One or more abnormities mentioned above could be found in 36.8% CS patients and were more likely to be found in female patients (P < 0.01). We concluded that CS is not a simple abnormity, due to the high incidence of associated deformities of other organs, comprehensive assessment was strongly recommended before the surgical correction for CS patients.
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Affiliation(s)
- Yong-tai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Abstract
Sixty-seven adolescent scoliosis patients with thoracic curve (Lenke type 1, 3, and 6) and 16 nonthoracic curve patients (Lenke type 5) were evaluated with color Doppler echocardiography to identify and compare the prevalence and frequency of valvular regurgitation. Regurgitation of one or more valves was detected in 36 thoracic curve patients (53.73%) and seven nonthoracic curve patients (43.75%). Regurgitation with tricuspid valve involvement was statistically significant in patients with thoracic curve (P=0.0216). Frequency of tricuspid valve involvement was statistically significant (28.57 vs. 83.33%, P=0.0076) in patients with thoracic curve. Those without cardiac disease had a higher incidence of valvular regurgitation.
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Liu L, Xiu P, Li Q, Song Y, Chen R, Zhou C. Prevalence of cardiac dysfunction and abnormalities in patients with adolescent idiopathic scoliosis requiring surgery. Orthopedics 2010; 33:882. [PMID: 21162511 DOI: 10.3928/01477447-20101021-08] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The prevalence of cardiac abnormalities in patients with adolescent idiopathic scoliosis in an Asian population has not been reported. A retrospective study was conducted to evaluate the incidence of cardiac abnormalities in these patients. From January 2007 to April 2009, echocardiography and pulmonary function tests were performed in 80 adolescent idiopathic scoliosis patients who required surgical intervention. A thorough analysis of cardiopulmonary functions and cardiac structures was performed. The risk factors, types of cardiac abnormalities, and associations between severity of scoliosis or pulmonary function and cardiac abnormalities were assessed. Cardiac abnormalities were detected by echocardiogram in 25 patients, including 14 with structural abnormalities and 11 with functional abnormalities. The most common functional abnormality was tricuspid regurgitation (9 of 80; 11.3%), whereas atrial septal defect was the most common structural abnormality (7 of 80). Altered hemodynamics occurred in 5 patients, including 3 with ventricular septal defect and 2 with mitral valve dysplasia. Abnormal electrocardiographic findings presented in only 9 of the 25 patients with cardiac abnormalities. No significant associations were found between severity of scoliosis or pulmonary function and cardiac abnormalities. A high incidence of cardiac abnormality exists in patients with adolescent idiopathic scoliosis in this region. Although most patients tolerated surgery, some patients were at risk of decompensation postoperatively. Electrocardiography is of limited value for detecting cardiac problems in patients with adolescent idiopathic scoliosis, we recommend echocardiography as a routine modality in the preoperative evaluation of patients with adolescent idiopathic scoliosis.
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Affiliation(s)
- Limin Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
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16
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Abstract
Scoliosis is caused by the lateral displacement and rotation of the vertebral bodies. It is most common during periods of rapid somatic growth. Scoliosis impedes on the movement of the ribs, places the respiratory muscles at a mechanical disadvantage and displaces the various organs of the thoracic cavity. Scoliosis decreases the chest wall compliance directly and the lung compliance indirectly (due to progressive atelectasis and air-trapping), causing a significant increase in the work of breathing that, because of the associated respiratory muscle weakness may lead to chronic respiratory failure. Progressive pulmonary hypertension also constitutes a leading cause for morbidity and mortality. Scoliosis is not reversible, but it can be controlled. Routine screening should start early and continue until the child reaches skeletal maturation. Pulmonary function testing can provide an easy and reliable means for the evaluation and follow-up of the condition.
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Affiliation(s)
- Anastassios C Koumbourlis
- Albert Einstein College of Medicine, and Division of Pulmonary Medicine, Schneider Children's Hospital, New Hyde Park, New York, NY 11040, USA.
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Abstract
This study was designed to determine the reasons for the variability of the incidence of congenital heart disease (CHD), estimate its true value and provide data about the incidence of specific major forms of CHD. The incidence of CHD in different studies varies from about 4/1,000 to 50/1,000 live births. The relative frequency of different major forms of CHD also differs greatly from study to study. In addition, another 20/1,000 live births have bicuspid aortic valves, isolated anomalous lobar pulmonary veins or a silent patent ductus arteriosus. The incidences reported in 62 studies published after 1955 were examined. Attention was paid to the ways in which the studies were conducted, with special reference to the increased use of echocardiography in the neonatal nursery. The total incidence of CHD was related to the relative frequency of ventricular septal defects (VSDs), the most common type of CHD. The incidences of individual major forms of CHD were determined from 44 studies. The incidence of CHD depends primarily on the number of small VSDs included in the series, and this number in turn depends upon how early the diagnosis is made. If major forms of CHD are stratified into trivial, moderate and severe categories, the variation in incidence depends mainly on the number of trivial lesions included. The incidence of moderate and severe forms of CHD is about 6/1,000 live births (19/1,000 live births if the potentially serious bicuspid aortic valve is included), and of all forms increases to 75/1,000 live births if tiny muscular VSDs present at birth and other trivial lesions are included. Given the causes of variation, there is no evidence for differences in incidence in different countries or times.
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Affiliation(s)
- Julien I E Hoffman
- Department of Pediatrics and the Cardiovascular Research Institute, University of California, San Francisco, California 94143, USA.
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Guide SV, Holland SM. Host susceptibility factors in mycobacterial infection. Genetics and body morphotype. Infect Dis Clin North Am 2002; 16:163-86. [PMID: 11917812 DOI: 10.1016/s0891-5520(03)00051-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Through identification and evaluation of mutations and polymorphisms in components of the IFN gamma response pathways, a better understanding of the mechanisms and risk factors influencing the development of mycobacterial disease is gained. This may lead the way for development of therapeutic and preventative strategies. Although conventional science has focused on identifying discrete mutations, greater awareness of the impact of subtle changes, both at the genetic (polymorphisms) and physical levels (body morphotype), may prove critical in the investigative process. There has been extraordinary progress in the understanding of mycobacterial susceptibility factors over the last few years. The recognition of characteristic phenotypes will lead to the identification of new genetic bases for disease.
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Affiliation(s)
- Shireen V Guide
- Clinical Research Training Program, Stanford University, Palo Alto, California, USA
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