title: Brain changes in newborns, infants and children with congenital heart disease in association with cardiac surgery. Additional observations.
abstract: The histopathologic pattern in the Central Nervous System in 12 out of 21 new-borns and young infants, below 2 months of age, operated for various congenital heart defects, is that of recent necroses in the deep and subcortical white matter of the pallium, seen from a few hours to 8 days following completion of surgery. Type and location of these lesions of ischemic coagulative necrosis, resembling findings in the perinatal respiratory distress syndrome, seem to depend on shock-like states, the low output syndrome of the left heart with hypovolemia and hypotension. The cause of death in all these infants was cardio-respiratory failure. The question to what extent glial scars replacing necroses within the mostly non-myelinated fiber systems of the pallium will lead to defective maturation of the brain in later infancy and childhood remains a challenge for neurologic and psychological investigation, even if the heart defect has been successfully repaired by the surgeon. Post-mortem data of the CNS in 24 older infants and children below 9 years of age in association with cardia surgery include thrombembolic infarctions, also, after catheterization alone, diffuse or segmental cortical necroses, and cortical scars, especially in children older than 1 year, confirming data recently reported from this laboratory.
mesh_terms: D001921:Brain / Q000503:physiopathology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D005260:Female; D005911:Gliosis; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009336:Necrosis; D013923:Thromboembolism / Q000209:etiology