Patterns of Brain Damage in Infants and Children With Congenital Heart Disease

Abstract

Detailed histologic analysis of the brain in 500 patients with congenital heart defects revealed a relatively common occurrence (above 17%) of thromboembolic infarctions. They occurred four to five times more often in surgical than in nonsurgical cases, with 18 in direct association with catheterization and 21 following catheterization and surgical procedures. Careful search of meningeal arteries around infarcted areas is essential for recognizing the thromboemboli. Anoxic cortical necroses, diffuse or segmental, were four times higher in the surgical group, depending on gradual or rapid reduction of blood flow during and after cardiac surgery. Except for the early infancy group, venous thromboses causing infarctions were uncommon. Cardiac catheterization within the neonatal period proved hazardous in 21 cases in infants with severe anomalies. Continued febrile episodes following catheterization or surgery might suggest an acquired or preexisting encephalitis for which viral studies are indicated.