Neurologic Sequelae of Open-Heart Surgery in Children
- 1 March 1990
- journal article
- research article
- Published by American Medical Association (AMA) in American Journal of Diseases of Children
- Vol. 144 (3), 369-373
- https://doi.org/10.1001/archpedi.1990.02150270119040
Abstract
• As pediatric cardiac surgical techniques have improved in recent years, mortality rates have dropped and attention has turned to residual morbidity, especially neurologic sequelae. Although the majority of children undergoing open-heart surgery for correction of congenital heart defects apparently emerge with no adverse consequences, a small percentage suffer permanent neurologic injury (seizures, motor disorders). Another small and not well-defined population may be left with disorders of higher cortical function, such as mental retardation or learning disabilities. A survey of six major pediatric cardiac surgery units in North America was undertaken in 1988-1989 to ascertain current approaches to the detection and management of neurologic sequelae of pediatric open-heart surgery. All units reported seeing a small but definite incidence of postoperative neurologic symptoms, including alterations of consciousness, seizures, and localized abnormalities such as hemiparesis or delayed choreoathetoid syndromes. Postoperative neuroimaging procedures have shown a disturbing incidence of hypoxicischemic encephalopathy, unsuspected cerebral atrophy, and subdural hematomas. Pathogenesis may include factors related to preoperative brain anomalies and/or hypoxic insults, altered cerebral blood flow and metabolism during hypothermic cardiopulmonary bypass with or without total circulatory arrest, embolization, and low cardiac output states postoperatively. Further studies are needed to examine the mechanisms of injury and to develop techniques to minimize the occurrence of these sequelae, as they may be associated with life-long neurologic disability and reduced quality of life. (AJDC. 1990;144:369-373)This publication has 27 references indexed in Scilit:
- Cardiac Surgery in the Federal Republic of Germany during 1988The Thoracic and Cardiovascular Surgeon, 1989
- The Role of Excitatory Amino Acids and NMDA Receptors in Traumatic Brain InjuryScience, 1989
- Choreic syndrome after cardiac surgery.Archives of Disease in Childhood, 1988
- Effect of pH and Pco2 on pulmonary and systemic hemodynamics after surgery in children with congenital heart disease and pulmonary hypertensionThe Journal of Pediatrics, 1988
- Loss of the Somatosensory Evoked Response as an Indicator of Reversible Cerebral Ischemia during Hypothermic, Low-flow Cardiopulmonary BypassThe Annals of Thoracic Surgery, 1988
- Cardiac Valve Replacement in Children: A Twenty-Year SeriesThe Annals of Thoracic Surgery, 1988
- Neurologic Sequelae of Cardiac Surgery in ChildrenArchives of Pediatrics & Adolescent Medicine, 1987
- Developmental Outcome in Children Undergoing Surgery with Profound HypothermiaAnesthesiology, 1986
- Neuropsychiatric Complications after Cardiopulmonary BypassAnesthesiology, 1986
- Autoregulation of brain blood flow in the newborn piglet: Regional differences in flow reduction during hypotensionEarly Human Development, 1982