Transient cortical blindness after heart surgery in a child patient -A case report-

Abstract

Visual loss occurring after pediatric cardiac surgery employing cardiopulmonary bypass (CPB) is relatively rare but the risk is substantial. Compromised cerebral perfusion due to a CPB related micro-embolization and inflammatory vascular changes as well as reduced oxygen carrying capacity in hemodilution and hypothermia during CPB might be major contributing factors to the development of postoperative visual loss after cardiac surgery with CPB. A case of immediate but transient postoperative visual loss was encountered in a 21-month-old male who underwent tricuspid valve surgery. Despite routine intraoperative measures to maintain an adequate perfusion pressure throughout the procedure, postoperative computed tomography revealed a subacute infarct in his occipital lobe. Recovery began on postoperative day 28, and the patient's vision was restored by 31 days.

Decompression of superior vena cava during bidirectional Glenn shunt: A simple but risky technique

“…[7] Recovery has been reported to begin after 28 days, [8] but in the present case even four months postoperatively, restoration of vision was only up to the perception of light. Acid base balance must be maintained preferably by the pH-stat method and whole blood or packed cells should be used for pump priming.…”

Transient cortical blindness following intracardiac repair of congenital heart disease in an 11-year-old boy

“…Following CB the loss of vision may be permanent or transient. [ 12 13 14 15 ] The recovery of vision if happens may take variable period depending on various factors. Best prognosis has been observed in patients under the age of 40 years, in those without a history of hypertension or diabetes mellitus, and in those without associated cognitive, language, or memory impairments.…”

Transient Bilateral Blindness in a Patient after Cardiac Surgery

“…Shen et al analyzed the data for more than 5.6 million patients who underwent various nonophthalmic surgeries between 1996 and 2005, and found that cardiac surgery had the highest rates of perioperative visual loss among nonophthalmic surgeries, specifi cally 8.64 cases per 10,000 patients [Shen 2009]. These cases are usually caused by emboli, hypotension, acute anemia, hypoxia, intraparenchymal hemorrhage, or a combination of these factors [Slavin 1987;Shahian 1989;Moster 1998;Chen 2000;Sha'aban 2000;Loubani 2001;Suzuki 2001;Bagheri 2008;Thurtell 2008;Shin 2010]. In the case of our patient, these causes have been carefully considered and ruled out by the workup of the neurology, ophthalmology, and neuro-ophthalmology services.…”