Adults following open esophageal atresia repair: evaluating long-term musculoskeletal and pulmonary outcomes using insights from real-time MRI

Background EA survivors face long-term morbidity after thoracotomy with adult outcomes largely uninvestigated. This study assessed musculoskeletal and pulmonary outcomes in adults who underwent neonatal thoracotomy for EA using real-time magnetic resonance imaging (rt-MRI). Methods Between 09/2022 and 02/2023, 30 adult EA patients and 22 healthy controls underwent rt-MRI to evaluate chest wall motion, lung volumes, and anatomical deformities. Thoracic cross-sectional area (CSA), lung volumes, and rib/spinal abnormalities were analyzed using a 3 Tesla MRI system. Results Rib adhesions and fusions were significantly more frequent in EA patients (90%) than in controls ( p < 0.01). Scoliosis was present in 43% of patients, with many cases moderate to severe ( p < 0.05). EA patients showed reduced thoracic CSA and lung volumes on the operated side ( p < 0.01) and significantly impaired chest wall motility ( p < 0.05). Scoliosis prevalence was higher in adults (43%) than in children (14%) ( p < 0.05). Conclusion This study demonstrates the significant long-term musculoskeletal and pulmonary sequelae in adults following open EA repair, with the pioneering application of rt-MRI. These findings emphasize the risks associated with open surgery for EA, underscoring the need for long-term, multidisciplinary follow-up and preventive strategies. Impact This is the first study to use real-time MRI to assess dynamic thoracic function in adults after open repair of esophageal atresia (EA), revealing significant long-term musculoskeletal and pulmonary impairments. Findings include high rates of scoliosis, rib anomalies, and reduced chest wall motility and lung volume on the operated side. Results underscore the need for long-term, multidisciplinary follow-up and inform future strategies to reduce morbidity after neonatal thoracotomy.