Neurologic Sequelae of Open-Heart Surgery in Children

Ferry, Peggy C.

doi:10.1001/archpedi.1990.02150270119040

Cited by 232 publications

(88 citation statements)

References 27 publications

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“…1,2 Survivors are at higher risk for significant neurological deficits or developmental disabilities including impaired visual-motor skills and behavioral abnormalities at school age. 1,3,4 Various studies have reported that infants who undergo cardiac surgery are at risk for developing postoperative seizures, ischemic lesions on magnetic resonance imaging (MRI), and abnormal neurological examinations 1 year after surgery.…”

Section: Introductionmentioning

confidence: 99%

Neurologic events in neonates treated surgically for congenital heart disease

et al. 2006

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Objective: The incidence of acute neurologic events prior to discharge in neonates with congenital heart disease (CHD) was determined and peri-operative characteristics predictive of a neurologic event were identified.Study design: A retrospective chart review over 1 year was conducted of infants <1 month of age with a diagnosis of CHD. Outcomes were measured by the occurrence of an acute neurologic event defined as electroencephalogram (EEG)-proven seizure activity, significant hypertonia or hypotonia, or choreoathetosis prior to hospital discharge.Stepwise logistic regression identified variables most likely to be associated with an acute neurologic event.Results: Surgical intervention occurred in 95 infants who were admitted with a diagnosis of CHD. The survival rate was 92%. Of the survivors, 16 (17%) had an acute neurologic event, with 19% of events occurring preoperatively. Factors associated with neurologic events included an elevated nucleated red blood cell (NRBC) count, an abnormal preoperative brain imaging study, and a 5-min Apgar score <7 (P<0.05). Conclusions:Neonates with CHD have a significant risk of neurologic events. Preoperative brain imaging, the 5-min Apgar score, and initial serum NRBC counts may identify infants at highest risk for central nervous system injury.

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Section: Introductionmentioning

confidence: 99%

Neurologic events in neonates treated surgically for congenital heart disease

et al. 2006

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“…Neurologic injury after repair of congenital heart anomalies remains an important problem (Ferry, 1990). The findings of this study suggest that MK-801 may be a useful agent in accelerating acute re covery of cerebral metabolism after hypothermic circulatory arrest as is commonly used for cardiac repair in neonates and infants.…”

Section: Discussionmentioning

confidence: 84%

“…However, hypothermia alone does not provide satisfactory cerebral protec tion during relatively long (>45 min) periods of cir culatory arrest (Kirklin and Barratt-Boyes, 1992). Neurologic abnormalities, including seizures and developmental delay, are reported in neonates and infants after hypothermic circulatory arrest (Ferry, 1990). Another characteristic complication in in fants is choreoathetosis (Brunberg et aI., 1974;Wong et aI., 1992).…”

Section: Discussionmentioning

confidence: 99%

Effects of MK-801 and NBQX on Acute Recovery of Piglet Cerebral Metabolism after Hypothermic Circulatory Arrest

Aoki

Nomura

Stromski

et al. 1994

J Cereb Blood Flow Metab

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Summary:Brain protection during open heart surgery in the neonate and infant remains inadequate. Effects of the excitatory neurotransmitter antagonists MK-801 and NBQX on recovery of brain cellular energy state and met abolic rates were evaluated in 34 4-week-old piglets (10 MK-801, 10 NBQX, 14 controls) undergoing cardiopul monary bypass and hypothermic circulatory arrest at 15°C nasopharyngeal temperature for 1 h, as is used clin ically for repair of congenital heart defects. MK-801 (di zocilpine) (0.75 mg/kg) or NBQX [2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(F)quinoxaline] (25 mg/kg) was given intravenously before cardiopulmonary bypass. Equiva lent doses were placed in the cardiopulmonary bypass prime plus continuous infusions after reperfusion (0.15 mg kg-1h-1 and 5 mg kg-1h -I ) . Changes in high-energy phosphate concentrations and pH were analyzed by mag netic resonance spectroscopy in 17 animals until 225 min after reperfusion. Cerebral blood flow determined by ra dioactive microspheres as well as cerebral oxygen and glucose consumption were studied in 17 other animals. Cerebral blood flow and oxygen consumption were deOver the last decade, the surgical mortality for repair of congenital heart defects has declined dra matically. In addition, there has been a trend to Received January 11, 1993; final revision received June 28, 1993; accepted June 29, 1993. Address correspondence and reprint requests to Dr. Richard A. Jonas, Department of Cardiovascular Surgery, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, U.S.A.Abbreviations used: AMPA, a-amino-3-hydroxy-5-methyl-4-isoxazole; ANOVA, analysis of variance; AV, arteriovenous; CPB, cardiopulmonary bypass; NBQX, 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo(F)quinoxaline; MANDV A, multivariate analy sis of variance; NMDA, N-methyl-D-aspartate. gen consumption recovered to 105 ± 30% baseline in group MK-801 and 94 ± 31% in control but only to 61 ± 22% in group NBQX (p = 0.070). Cerebral blood flow stayed significantly lower in group NBQX relative to con trol. Thus, MK-801 accelerates recovery of cerebral high energy phosphates and metabolic rate after cardiopulmo nary bypass and hypothermic circulatory arrest in the immature animal. At the dosage used NBQX exerts an adverse effect. Key Words: Excitatory neurotransmitter antagonist-Ischemia-Magnetic resonance spectros copy-Hypothermia-Immature-Heart surgery.perform primary repair in the neonatal period and early infancy (Castaneda et aI., 1984(Castaneda et aI., , 1989 Di Do nato et aI., 1991). Increasing attention has been fo cused on the quality of life of those patients surviv ing surgery. Open heart surgery in the neonate and infant often requires cessation of total body perfu sion for precise operation in a very small heart or because of aortic arch and/or venous return anom alies. Currently, deep systemic hypothermia « 18°C) is the only major strategy employed for protection of the brain and systemic organs during this total body ischemia. However, hypothermia

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“…The central nervous system (CNS) is the entity with highest exposure to ischemic injury in this context, with risk assessed between 2% and 61% 5,[30][31][32][33] . Possible CNS injuries during surgery include: relatively low effectiveness of blood filters; occlusion of the descending aorta; microemboli formed from ruptured atherosclerotic plaques or coming from dilated heart chambers; air entering the system; fatty embolism; coagulation disorders; hypotension; and nonpulsing flow.…”

Section: Discussionmentioning

confidence: 99%