Increased Musculoskeletal Deformities and Decreased Lung Volume in Patients After EA/Tef Repair: A Real-time MRI Study.

OBJECTIVE

This study aims to assess morphologic and functional postoperative changes after open or minimally invasive (MIS) repair of esophageal atresia (EA) compared with healthy controls by thoracic real-time magnetic resonance imaging (MRI).

BACKGROUND

Musculoskeletal deformities and pulmonary morbidity are common in children after EA repair. The real-time MRI is a novel technique that provides ultrafast, high-quality images during spontaneous breathing, without sedation, even in young children.

METHODS

Children aged 3 to 18 years were prospectively examined with a 3 Tesla MRI. Musculoskeletal deformities, static thoracic cross-sectional areas (CSAs) at 3 different levels and lung volumes, as well as dynamic right-to-left ratio of CSA of hemithoraces and lung volumes during forced breathing were evaluated.

RESULTS

Seventy-two children (42 open, 8 MIS, 22 controls) were recruited. In the EA group, rib fusions and adhesions (78%, P <0.01) and scoliosis (15%, P =0.32) were found after thoracotomy but not after MIS. The mean right-to-left ratio of CSA and lung volumes were lower after EA repair compared with controls ( P <0.05), indicating impaired thoracic and lung development. The number of thoracotomies was a significant risk factor for smaller thoracic volumes ( P <0.05).

CONCLUSIONS

For the first time, morphologic changes and thoracic motility after EA repair were visualized by dynamic real-time MRI. After EA repair, children show decreased right-sided thoracic and lung development compared with controls. Open repair leads to significantly more musculoskeletal deformities. This study emphasizes that musculoskeletal morbidity following a thoracotomy in infancy is high.