Long-Term MRI Changes in Brain After Pediatric Open Heart Surgery

Abstract

We performed magnetic resonance imaging (MRI) on the brain and neurologic examinations on 23 children after open heart surgery for congenital heart disease. Twenty children also had psychometric assessments. Examinations were performed at a mean age of 66 months (range, 26 to 180 months). Age at operation was less than 1 month in 43% and more than 6 months in 45%. Abnormal scans were found in 17 (74%) and showed diffuse findings consistent with hypoxic-ischemic encephalopathy, with or without areas of cortical infarction; focal cortical infarction alone; and (in one patient) callosal agenesis and abnormal neuronal migration. Normal IQ and neurologic examinations were found in all six of those who had a normal MRI, and five of six children with changes consistent with focal cortical infarction without diffuse change had a normal neurologic examination. Cerebral palsy and mental retardation was common in the group with diffuse abnormality (in eight of nine children), and this was more likely to occur in those who underwent prolonged (> 45 minutes) hypothermic circulatory arrest and operation during early infancy (P = .004). Focal cortical findings without diffuse changes were more likely in those who underwent open heart surgery without hypothermic circulatory arrest and were older than 6 months at operation, and these children were less likely to have frank neurodevelopmental sequelae. Thus, in our population, focal cortical lesions were common after open heart surgery, and, in addition, diffuse brain abnormality on MRI plus neurologic sequelae were common after prolonged hypothermic circulatory arrest.

Stroke in Childhood

“…16 Clinical and silent cerebral infarction have also been reported in relation to cardiac surgery for congenital heart disease. 17,18 Similar data exist for adults undergoing coronary artery bypass grafting surgery. 19…”

Outcome After Open-Heart Surgery in Infants and Children

“…Various studies have reported that preexisting brain damage may be detected by neuroimaging before operation, and even in those without chromosomal aberrations or multiple minor congenital anomaly syndromes, congenital brain anomalies may be present. [22][23][24][25] Seizures after open-heart surgery are frequent and were recorded in 10% of our population. 26--28 They were not associated with any study variable.…”

Cerebrovascular disorders in children

“…The risk of stroke in children with CHD is related to the underlying abnormality, diagnostic and surgical procedures, and associated genetic or acquired factors that predispose children to thrombosis. Silent infarction may also occur as demonstrated by neuroimaging studies that revealed permanent neurologic damage in infants undergoing cardiac surgery for CHD [18]. A pre-and postoperative magnetic resonance imaging (MRI) study of 24 infants undergoing pediatric surgery revealed that 67% of cases developed new lesions or worsening of preoperative lesions [17].…”