This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Geoffrey Miller, MD; Kathleen D. Eggli, MD; Charles Contant, PhD; Barry G. Baylen, MD; John L. Myers, MD

Arch Pediatr Adolesc Med. 1995;149(7):764-768.

Abstract
Objective
To ascertain the relation between postoperative neurologic complications and variables occurring before, during, and after hypothermic cardiopulmonary bypass surgery to correct congenital heart disease in young infants.

Design
Prospective analysis of mortality and neurologic morbidity before hospital discharge; systematic comparison with patient characteristics, metabolic status, surgery variables; and preoperative neurologic findings of the patients.

Setting
Intensive care unit in tertiary care center.

Patients
Consecutive sample of 91 full-term infants who underwent 100 operations between January 1989 through December 1992. Nine infants had more than one operation during the study period.

Main Outcome Measures
Levels of alertness, tone, focal signs, dyskinesia, pyramidal signs, seizures, and death.

Results
Reduced level of alertness at discharge from the hospital in 19% of patients; seizures in 15% (70% focal); severe hypotonia in 11% before surgery, and in 7% at discharge from hospital; generalized pyramidal findings in six (7%); asymmetry of tone in 5%; and chorea that did not persist in 11%. Results of cranial ultrasound tests were abnormal in 20% of patients. Of these those with abnormal cranial ultrasound examinations 55% were abnormal before surgery. Overall mortality was 18%. Of the patients who died, 59% had interrupted aortic arch or hypoplastic left heart syndrome. Mortality for patients with these lesions was 40%. Alertness (P=.005), chorea (P=.03), and hypotonia (P=.02) were associated with duration of deep hypothermia longer than 60 minutes. No association was found among other outcomes and study variables, except the relation between severe left-sided heart lesions and mortality.

Conclusions
Mortality and neurologic morbidity after open heart surgery on young infants may be due to several factors, including type of lesion, preexisting brain abnormalities, duration of deep hypothermia, and strokes.

(Arch Pediatr Adolesc Med. 1995;149:764-768)

Author Affiliations
From the Section of Pediatric Neurology (Dr Miller) and Neurosurgery (Dr Contant), Baylor College of Medicine, Houston, Tex; and the Departments of Radiology (Dr Eggli), Cardiology (Dr Baylen), and Cardiothoracic Surgery (Dr Myers), Pennsylvania State University, Hershey.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Balloon atrial septostomy let's take a closer look.
Mosca
J Am Coll Cardiol 2009;53:1812-1813.
FULL TEXT  

An Assessment of the Effects of General Anesthetics on Developing Brain Structure and Neurocognitive Function
Loepke and Soriano
Anesth. Analg. 2008;106:1681-1707.
ABSTRACT | FULL TEXT  

Neurodevelopmental Implications of Congenital Heart Disease
Padula and Ades
NeoReviews 2006;7:e363-e369.
FULL TEXT  

Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: Neurodevelopmental outcome
Karl et al.
J. Thorac. Cardiovasc. Surg. 2004;127:213-222.
ABSTRACT | FULL TEXT  

Risk of Seizures in Survivors of Newborn Heart Surgery Using Deep Hypothermic Circulatory Arrest
Clancy et al.
Pediatrics 2003;111:592-601.
ABSTRACT | FULL TEXT  

A cohort study of neurodevelopmental outcome in children with DiGeorge syndrome following cardiac surgery
Maharasingam et al.
Arch. Dis. Child. 2003;88:61-64.
ABSTRACT | FULL TEXT  

A Glial-Derived Protein, S100B, in Neonates and Infants with Congenital Heart Disease: Evidence for Preexisting Neurologic Injury
Bokesch et al.
Anesth. Analg. 2002;95:889-892.
ABSTRACT | FULL TEXT  

Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation
Hovels-Gurich et al.
J. Thorac. Cardiovasc. Surg. 2002;124:448-458.
ABSTRACT | FULL TEXT  

Current incidence of acute neurologic complications after open-heart operations in children
Menache et al.
Ann. Thorac. Surg. 2002;73:1752-1758.
ABSTRACT | FULL TEXT  

Cerebral oxygen saturation before congenital heart surgery
Kurth et al.
Ann. Thorac. Surg. 2001;72:187-192.
ABSTRACT | FULL TEXT  

Association Between Electroencephalographic Findings and Neurologic Status in Infants With Congenital Heart Defects
Limperopoulos et al.
J Child Neurol 2001;16:471-476.
ABSTRACT  

Allopurinol Neurocardiac Protection Trial in Infants Undergoing Heart Surgery Using Deep Hypothermic Circulatory Arrest
Clancy et al.
Pediatrics 2001;108:61-70.
ABSTRACT | FULL TEXT  

Time course of cranial ultrasound abnormalities after arterial switch operation in neonates
Sigler et al.
Ann. Thorac. Surg. 2001;71:877-880.
ABSTRACT | FULL TEXT  

Pitfalls in neonatal cardiac surgery using antegrade cerebral perfusion
van Haaren et al.
J. Thorac. Cardiovasc. Surg. 2001;121:0184-186.
FULL TEXT  

PREOPERATIVE RISK-OF-DEATH PREDICTION MODEL IN HEART SURGERY WITH DEEP HYPOTHERMIC CIRCULATORY ARREST IN THE NEONATE
Clancy et al.
J. Thorac. Cardiovasc. Surg. 2000;119:347-357.
ABSTRACT | FULL TEXT  

Neurologic Status of Newborns With Congenital Heart Defects Before Open Heart Surgery
Limperopoulos et al.
Pediatrics 1999;103:402-408.
ABSTRACT | FULL TEXT  

Early Developmental Outcome After the Norwood Procedure for Hypoplastic Left Heart Syndrome
Kern et al.
Pediatrics 1998;102:1148-1152.
ABSTRACT | FULL TEXT  

Early Neurologic Outcome After Open Heart Surgery on Young Infants-Reply
Miller and Baylen
Arch Pediatr Adolesc Med 1996;150:561-561.
ABSTRACT  

Early Neurologic Outcome After Open Heart Surgery on Young Infants
Rosti et al.
Arch Pediatr Adolesc Med 1996;150:560-561.
ABSTRACT