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Arch Pediatr Adolesc Med. 1995 Jul;149(7):764-8.

Postoperative neurologic complications after open heart surgery on young infants.

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  • 1Section of Pediatric Neurology, Baylor College of Medicine, Houston, Tex., USA.

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.

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PMID:
7795766
[PubMed - indexed for MEDLINE]
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