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March 1987, Vol 141, No. 3 >
Article | March 1987

Neurologic Sequelae of Cardiac Surgery in Children FREE

Peggy C. Ferry, MD
[+] Author Affiliations

Accepted for publication Sept 9, 1986.

Presented in part at the Fourth International Child Neurology Congress, Jerusalem, March 20, 1986.

Reprint requeststo the Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, AZ 85724 (Dr Ferry).


Am J Dis Child. 1987;141(3):309-312. doi:10.1001/archpedi.1987.04460030087032.
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• Major advances in surgical and cardiopulmonary bypass technology have occurred in the past 30 years. Total correction of previously inoperable congenital cardiac defects is being performed with increasing frequency and in children at progressively younger ages. While the majority of children undergoing cardiac surgery survive without incident, increasing concern is being raised about neurologic sequelae seen in some survivors. Complications such as embolization, hypoxia, inadequate cerebral perfusion, and biochemical disturbances may all lead to brain damage following cardiac surgery. Acute postoperative neurologic problems include seizures, impaired levels of consciousness, focal motor deficits, and movement disorders. Long-term sequelae include language and learning disorders, mental retardation, seizures, and cerebral palsy. Intraoperative cerebral monitoring techniques are as yet imperfect, but their use in combination with meticulous intraoperative and postoperative care currently provides the best means reducing neurologic morbidity. Future tudies should explore other methods of preserving neurologic integrity in chilren undergoing open heart surgery.

(AJDC 1987;141:309-312)

REFERENCES

1 +
Moller JH:  Incidence of cardiac malformation , in Moller JH, Neal WA (eds): Heart Disease in Infancy . East Norwalk, Conn, Appleton-Century-Crofts, 1982;, p 1.
2 +
Gibbon JH:  Application of a mechanical heart and lung apparatus to cardiac surgery . Minn Med 1954;;37:171-180.
3 +
Lansing AM, Girardat RE, Masri Z:  Mortality in pediatric cardiac surgery: Review of a seven-year experience with 944 operations . J Ky Med Assoc 1984;;82:273-277.
4 +
Branthwaite MA:  Prevention of neurological damage during open-heart surgery . Thorax 1975;;30:258-261.
5 +
Wells FC, Coghill S, Caplan HL, et al:  Duration of circulatory arrest does influence the psychological development of children after cardiac operations in early life . J Thorac Cardiovasc Surg 1983;;86:823-831.
6 +
Sotaniemi KA:  Five-year neurological and EEG outcome after open-heart surgery . J Neurol Neurosurg Psychiatry 1985;;48:569-575.
7 +
Russell RW, Bharucha N:  The recognition and prevention of border zone cerebral ischemia during cardiac surgery . Q J Med 1978;;187: 303-323.
8 +
Aberg T, Ronquist G, Tyden H, et al:  Adverse effects on the brain in cardiac operations as assessed by biochemical, psychometric, and radiologic methods . J Thorac Cardiovasc Surg 1984;;87:99-105.
9 +
Brunberg JA, Reilly EL, Doty DB:  Central nervous system consequences in infants of cardiac surgery using deep hypothermia and circulatory arrest . Circulation 1974;;50( (suppl 2) ):60-66.
10 +
Kirklin JW, Barratt-Boyes BG (eds): Cardiac Surgery . New York, John Wiley & Sons, 1986;.
11 +
Ehyai A, Fenichel GM, Bender HW Jr:  Incidence and prognosis of seizures in infants after cardiac surgery with profound hypothermia and circulatory arrest . JAMA 1984;;252: 3165-3167.
12 +
Muraoka R, Yokota M, Aoshima M, et al:  Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain . J Thorac Cardiovasc Surg 1981;;81:364-369.
13 +
Puntis JW, Green SH:  Ischaemic spinal cord injury after cardiac surgery . Arch Dis Child 1985;;60:517-520.
14 +
Hungxi S, Xiaoquin H, Kongsoon L, et al:  Intracranial hemorrhage and hematoma following open-heart surgery , in Becker R, Katz J, Polonius MJ, et al (eds): Psychopathological and Neurological Dysfunctions Following OpenHeart Surgery . New York, Springer-Verlag NY Inc, 1982;, pp 293-299.
15 +
Lederman RJ, Breuer AC, Hanson MR, et al:  Peripheral nervous system complications of coronary artery bypass graft surgery . Ann Neurol 1982;;12:297-301.
16 +
Longmore D:  Causes of cerebral complications after open-heart surgery , in Speidel H, Rodewald G (eds): Psychic and Neurological Dysfunctions after Open-Heart Surgery: First International Symposium . New York, Georg Thieme Verlag, 1980;, pp 76-91.
17 +
Kirklin JK, Kirklin JW, Pacifico AD:  Deep hypothermia and total circulatory arrest , in Arciniegas E (ed): Pediatric Cardiac Surgery . Chicago, Year Book Medical Publishers Inc, 1985;, p 80.
18 +
Hickey PR:  Deep hypothermic circulatory arrest: Current status and future directions . Mt Sinai J Med 1985;;52:541-547.
19 +
Kirklin JK, Kirklin JW, Pacifico AD:  Cardiopulmonary bypass , in Arciniegas E (ed): Pediatric Cardiac Surgery . Chicago, Year Book Medical Publishers Inc, 1985;.
20 +
Smith GH:  Complications of cardiac surgery , in Smith GH (ed): Complications of Cardiopulmonary Surgery . London, Bailliere Tindall, 1984;, p 103.
21 +
Aguilar MJ, Gerbode F, Hill JD:  Neuropathologic complications of cardiac surgery . J Thorac Cardiovasc Surg 1971;;61:676-685.
22 +
Orenstein JM, Sato N, Aaron B, et al:  Microemboli observed in deaths following cardiopulmonary bypass surgery: Silicone antifoam agents and polyvinyl chloride tubing as sources of emboli . Hum Pathol 1982;;13:1082-1090.
23 +
Malone M, Prior P, Scholtz CL:  Brain damage after cardiopulmonary by-pass: Correlations between neurophysiological and neuropathological findings . J Neurol Neurosurg Psychiatry 1981;;44:924-931.
24 +
Bozoky B, Bara D, Kertesz E:  Autopsy study of cerebral complications of congenital heart disease in cardiac surgery . J Neurol 1984;;231:156-161.
25 +
 Which heart valve prosthesis? , editorial. Lancet 1985;;2:756-758.
26 +
Byork VO, Ivert T:  Early and late neurological complications after prosthetic heart valve replacement , in Becker R, Katz J, Polonius MJ, et al (eds): Psychopathological and Neurological Dysfunctions Following Open-Heart Surgery . New York, Springer-Verlag NY Inc, 1982;, pp 3-15.
27 +
Khalil Y, Sethia B, Quin R, et al:  Disc and strut embolisation after minor strut fracture in a Bjork-Shiley mitrovalve prosthesis . Thorax[ill] 1985;;40:158-159.
28 +
Newburger JW, Silbert AR, Buckley LP[ill] et al:  Cognitive function and age at repair of transposition of the great arteries in children N Engl J Med 1984;;310:1495-1499.
29 +
Culbertson JL, Norlin PF, Ferry PC:  Communication disorders in childhood . J Pediatr Psy[ill] chol 1981;;6:69-83.
30 +
McCauley RJ, Swisher L:  Psychometric review of language and articulation tests for preschool children . J Speech Hear Disord 1984;;49:[ill] 34-42.
31 +
Clarkson PM, MacArthur BA, BarrattBoyes BG, et al:  Cardiac surgery in infancy using profound hypothermia and circulatory arrest[ill] Late developmental progress , in Becker R, Katz[ill] J, Polonius MJ, et al (eds): Psychopathological and Neurological Dysfunctions Following OpenHeart Surgery . New York, Springer-Verlag NY[ill] Inc, 1982;, pp 187-192.
32 +
Arnold SA, Brown OE, Finitzo T:  Hearing loss in children with congenital heart disease: A preliminary report . Int J Pediatr Otorhinolaryngol 1986;;11:287-293.
33 +
Markowicz RI, Kleinman CS, Hellenbrand WE, et al:  Communicating hydrocephalus secondary to superior vena caval obstruction . AJDC 1984;;138:638-641.
34 +
Miller DW, Binford JM, Hessel EA:  Results of a survey of the professional activities of 811 cardiopulmonary profusionists . J Thorac Cardiovasc Surg 1982;;83:385-389.
35 +
Maynard DE, Jenkinson JL:  The cerebral function analyzing monitor . Anaesthesia 1984;;39: 678-690.
36 +
Emerson RG, Chiappa KH:  Electrophysiologic monitoring , in Rapper AH, Kennedy SK, Zervas NT (eds): Neurological and Neurosurgical Intensive Care . Baltimore, University Park Press, 1983;, pp 133-154.
37 +
Mola M, Collice M, Lavati A:  Continuous intraoperative electroencephalographic monitor ing in carotid endarterectomy . Eur Neurol 1986;;25:53-60.
38 +
Lundar T:  Cerebral perfusion during cardiac surgery . Lancet 1986;;2:457.
39 +
Coles JG, Taylor MJ, Pearce JM, et al:  Cerebral monitoring of somatosensory evoked potentials during profoundly hypothermic circulatory arrest . Circulation 1984;;70( (suppl 1) ): 96-102.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Moller JH:  Incidence of cardiac malformation , in Moller JH, Neal WA (eds): Heart Disease in Infancy . East Norwalk, Conn, Appleton-Century-Crofts, 1982;, p 1.
2 +
Gibbon JH:  Application of a mechanical heart and lung apparatus to cardiac surgery . Minn Med 1954;;37:171-180.
3 +
Lansing AM, Girardat RE, Masri Z:  Mortality in pediatric cardiac surgery: Review of a seven-year experience with 944 operations . J Ky Med Assoc 1984;;82:273-277.
4 +
Branthwaite MA:  Prevention of neurological damage during open-heart surgery . Thorax 1975;;30:258-261.
5 +
Wells FC, Coghill S, Caplan HL, et al:  Duration of circulatory arrest does influence the psychological development of children after cardiac operations in early life . J Thorac Cardiovasc Surg 1983;;86:823-831.
6 +
Sotaniemi KA:  Five-year neurological and EEG outcome after open-heart surgery . J Neurol Neurosurg Psychiatry 1985;;48:569-575.
7 +
Russell RW, Bharucha N:  The recognition and prevention of border zone cerebral ischemia during cardiac surgery . Q J Med 1978;;187: 303-323.
8 +
Aberg T, Ronquist G, Tyden H, et al:  Adverse effects on the brain in cardiac operations as assessed by biochemical, psychometric, and radiologic methods . J Thorac Cardiovasc Surg 1984;;87:99-105.
9 +
Brunberg JA, Reilly EL, Doty DB:  Central nervous system consequences in infants of cardiac surgery using deep hypothermia and circulatory arrest . Circulation 1974;;50( (suppl 2) ):60-66.
10 +
Kirklin JW, Barratt-Boyes BG (eds): Cardiac Surgery . New York, John Wiley & Sons, 1986;.
11 +
Ehyai A, Fenichel GM, Bender HW Jr:  Incidence and prognosis of seizures in infants after cardiac surgery with profound hypothermia and circulatory arrest . JAMA 1984;;252: 3165-3167.
12 +
Muraoka R, Yokota M, Aoshima M, et al:  Subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain . J Thorac Cardiovasc Surg 1981;;81:364-369.
13 +
Puntis JW, Green SH:  Ischaemic spinal cord injury after cardiac surgery . Arch Dis Child 1985;;60:517-520.
14 +
Hungxi S, Xiaoquin H, Kongsoon L, et al:  Intracranial hemorrhage and hematoma following open-heart surgery , in Becker R, Katz J, Polonius MJ, et al (eds): Psychopathological and Neurological Dysfunctions Following OpenHeart Surgery . New York, Springer-Verlag NY Inc, 1982;, pp 293-299.
15 +
Lederman RJ, Breuer AC, Hanson MR, et al:  Peripheral nervous system complications of coronary artery bypass graft surgery . Ann Neurol 1982;;12:297-301.
16 +
Longmore D:  Causes of cerebral complications after open-heart surgery , in Speidel H, Rodewald G (eds): Psychic and Neurological Dysfunctions after Open-Heart Surgery: First International Symposium . New York, Georg Thieme Verlag, 1980;, pp 76-91.
17 +
Kirklin JK, Kirklin JW, Pacifico AD:  Deep hypothermia and total circulatory arrest , in Arciniegas E (ed): Pediatric Cardiac Surgery . Chicago, Year Book Medical Publishers Inc, 1985;, p 80.
18 +
Hickey PR:  Deep hypothermic circulatory arrest: Current status and future directions . Mt Sinai J Med 1985;;52:541-547.
19 +
Kirklin JK, Kirklin JW, Pacifico AD:  Cardiopulmonary bypass , in Arciniegas E (ed): Pediatric Cardiac Surgery . Chicago, Year Book Medical Publishers Inc, 1985;.
20 +
Smith GH:  Complications of cardiac surgery , in Smith GH (ed): Complications of Cardiopulmonary Surgery . London, Bailliere Tindall, 1984;, p 103.
21 +
Aguilar MJ, Gerbode F, Hill JD:  Neuropathologic complications of cardiac surgery . J Thorac Cardiovasc Surg 1971;;61:676-685.
22 +
Orenstein JM, Sato N, Aaron B, et al:  Microemboli observed in deaths following cardiopulmonary bypass surgery: Silicone antifoam agents and polyvinyl chloride tubing as sources of emboli . Hum Pathol 1982;;13:1082-1090.
23 +
Malone M, Prior P, Scholtz CL:  Brain damage after cardiopulmonary by-pass: Correlations between neurophysiological and neuropathological findings . J Neurol Neurosurg Psychiatry 1981;;44:924-931.
24 +
Bozoky B, Bara D, Kertesz E:  Autopsy study of cerebral complications of congenital heart disease in cardiac surgery . J Neurol 1984;;231:156-161.
25 +
 Which heart valve prosthesis? , editorial. Lancet 1985;;2:756-758.
26 +
Byork VO, Ivert T:  Early and late neurological complications after prosthetic heart valve replacement , in Becker R, Katz J, Polonius MJ, et al (eds): Psychopathological and Neurological Dysfunctions Following Open-Heart Surgery . New York, Springer-Verlag NY Inc, 1982;, pp 3-15.
27 +
Khalil Y, Sethia B, Quin R, et al:  Disc and strut embolisation after minor strut fracture in a Bjork-Shiley mitrovalve prosthesis . Thorax[ill] 1985;;40:158-159.
28 +
Newburger JW, Silbert AR, Buckley LP[ill] et al:  Cognitive function and age at repair of transposition of the great arteries in children N Engl J Med 1984;;310:1495-1499.
29 +
Culbertson JL, Norlin PF, Ferry PC:  Communication disorders in childhood . J Pediatr Psy[ill] chol 1981;;6:69-83.
30 +
McCauley RJ, Swisher L:  Psychometric review of language and articulation tests for preschool children . J Speech Hear Disord 1984;;49:[ill] 34-42.
31 +
Clarkson PM, MacArthur BA, BarrattBoyes BG, et al:  Cardiac surgery in infancy using profound hypothermia and circulatory arrest[ill] Late developmental progress , in Becker R, Katz[ill] J, Polonius MJ, et al (eds): Psychopathological and Neurological Dysfunctions Following OpenHeart Surgery . New York, Springer-Verlag NY[ill] Inc, 1982;, pp 187-192.
32 +
Arnold SA, Brown OE, Finitzo T:  Hearing loss in children with congenital heart disease: A preliminary report . Int J Pediatr Otorhinolaryngol 1986;;11:287-293.
33 +
Markowicz RI, Kleinman CS, Hellenbrand WE, et al:  Communicating hydrocephalus secondary to superior vena caval obstruction . AJDC 1984;;138:638-641.
34 +
Miller DW, Binford JM, Hessel EA:  Results of a survey of the professional activities of 811 cardiopulmonary profusionists . J Thorac Cardiovasc Surg 1982;;83:385-389.
35 +
Maynard DE, Jenkinson JL:  The cerebral function analyzing monitor . Anaesthesia 1984;;39: 678-690.
36 +
Emerson RG, Chiappa KH:  Electrophysiologic monitoring , in Rapper AH, Kennedy SK, Zervas NT (eds): Neurological and Neurosurgical Intensive Care . Baltimore, University Park Press, 1983;, pp 133-154.
37 +
Mola M, Collice M, Lavati A:  Continuous intraoperative electroencephalographic monitor ing in carotid endarterectomy . Eur Neurol 1986;;25:53-60.
38 +
Lundar T:  Cerebral perfusion during cardiac surgery . Lancet 1986;;2:457.
39 +
Coles JG, Taylor MJ, Pearce JM, et al:  Cerebral monitoring of somatosensory evoked potentials during profoundly hypothermic circulatory arrest . Circulation 1984;;70( (suppl 1) ): 96-102.

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