Patterns of Brain Damage in Infants and Children With Congenital Heart Disease

Developmental and Neurologic Status of Children after Heart Surgery with Hypothermic Circulatory Arrest or Low-Flow Cardiopulmonary Bypass

“…Periventricular leukomalacia, selective neuronal necrosis, focal or multifocal ischemic brain necrosis, and parasagittal cerebral lesions have been reported in infants with congenital heart disease. [28][29][30][31] White-matter injury, reported in infants after cardiac surgery, 28,29 could account for the observed motor deficits. The topography of both neuronal and white-matter injury after heart surgery in infants is consistent with ischemia as an important pathogenetic factor.…”

Neurological complications of heart disease in childhood

“…Monitoring somatosensory evoked potentials during surgery may be a useful way to identify cord ischaemia before irreversible damage has occurred'. Neuropathological studies have shown that thromboemboli arising in venous or arterial systems are often the cause of cerebrovascular injury in children with heart disease 8 and that polycythaemia is a predisposing factor'', Microcytosis will increase blood viscosity over and above the polycythaemia alone 10, and iron deficiency should be treated in cyanotic children even though haemoglobin may be high. Five of our patients with neurological injury unrelated to cardiac surgery had cyanotic heart disease and polycythaemia.…”

“…Neuropathological studies have shown that thromboemboli arising in venous or arterial systems are often the cause of cerebrovascular injury in children with heart disease 8 and that polycythaemia is a predisposing factor 9 . Microcytosis will increase blood viscosity over and above the polycythaemia alone 10 , and iron deficiency should be treated in cyanotic children even though haemoglobin may be high.…”

Cerebral infarction complicating Fontan surgery for cyanotic congenital heart disease

“…Terplan examined autopsy specimens from 500 patients with congenital heart disease and observed that the children who underwent surgery (including cardiac catheterization) were four to five times more likely to have evidence of CNS thromboembolic infarction than were the children who did not have surgery [13]. Immediately after cardiac surgery, 35%-50% of adult patients have clinical evidence of CNS disorders [8,14].…”