Postoperative neurologic complications after open heart surgery on young infants.
OBJECTIVE
To ascertain the relation between postoperative neurologic complications and variables occurring before, during, and after hypothermic cardiopulmonary bypass surgery to correct congenital heart disease in young infants.


METHODS
Prospective analysis of mortality and neurologic morbidity before hospital discharge; systematic comparison with patient characteristics, metabolic status, surgery variables; and preoperative neurologic findings of the patients.


METHODS
Intensive care unit in tertiary care center.


METHODS
Consecutive sample of 91 full-term infants who underwent 100 operations between January 1989 through December 1992. Nine infants had more than one operation during the study period.


METHODS
Levels of alertness, tone, focal signs, dyskinesia, pyramidal signs, seizures, and death.


RESULTS
Reduced level of alertness at discharge from the hospital in 19% of patients; seizures in 15% (70% focal); severe hypotonia in 11% before surgery, and in 7% at discharge from hospital; generalized pyramidal findings in six (7%); asymmetry of tone in 5%; and chorea that did not persist in 11%. Results of cranial ultrasound tests were abnormal in 20% of patients. Of these those with abnormal cranial ultrasound examinations 55% were abnormal before surgery. Overall mortality was 18%. Of the patients who died, 59% had interrupted aortic arch or hypoplastic left heart syndrome. Mortality for patients with these lesions was 40%. Alertness (P = .005), chorea (P = .03), and hypotonia (P = .02) were associated with duration of deep hypothermia longer than 60 minutes. No association was found among other outcomes and study variables, except the relation between severe left-sided heart lesions and mortality.


CONCLUSIONS
Mortality and neurologic morbidity after open heart surgery on young infants may be due to several factors, including type of lesion, preexisting brain abnormalities, duration of deep hypothermia, and strokes.
Miller
G
G
Section of Pediatric Neurology, Baylor College of Medicine, Houston, Tex., USA.
Eggli
K D
KD
Contant
C
C
Baylen
B G
BG
Myers
J L
JL
D001921:Brain / Q000473:pathology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D004453:Echoencephalography; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D007223:Infant; D007231:Infant, Newborn; D009422:Nervous System Diseases / Q000209:etiology*; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies