title: Profound hypothermia with alpha-stat pH management during open-heart surgery is associated with choreoathetosis.
abstract: A retrospective chart review was conducted to examine risk factors associated with the occurrence of choreoathetosis, a rare but significant complication of open-heart surgery in children. Ten children were identified as having developed choreoathetosis after cardiac surgery. Their charts were reviewed and compared with 33 age- and diagnosis-matched controls who underwent open-heart surgery during the same time period. Children with choreoathetosis reached lower rectal and esophageal temperatures (p = 0.0018 for both) and spent a greater portion of total bypass time at lower rectal and esophageal temperatures (p < 0.001 for both). Duration of cooling below 20 degrees C esophageal temperature and PaCO2 at the end of the cooling period were significant predictors of choreoathetosis (p = 0.023 and p = 0.0497, respectively) in a logistic regression model, and a greater fraction of choreoathetosis patients had prior developmental delays (p = 0.017). No difference was found in the age at surgery, duration of bypass, aortic cross-clamp time, arterial pH, PaCO2 or mean arterial pressure. The combination of extended exposure to profound hypothermia and alpha-stat pH management strategy and preexisting developmental delay are associated with the development of choreoathetosis following open-heart surgery 61 in children.
authors.affiliation: Division of Pediatric Cardiology, The Children's Hospital, University of Colorado Health Sciences Center, 1056 E. 19th Avenue, Denver, CO 80218, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Levin
authors.forename: A R
authors.initials: AR
authors.lastname: Seay
authors.forename: D A
authors.initials: DA
authors.lastname: Fullerton
authors.forename: E A F
authors.initials: EA
authors.lastname: Simoes
authors.forename: H M
authors.initials: HM
authors.lastname: Sondheimer
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology; D001264:Athetosis / Q000209:etiology*; D001831:Body Temperature; D002245:Carbon Dioxide; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002819:Chorea / Q000209:etiology*; D004947:Esophagus / Q000503:physiopathology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced / Q000009:adverse effects*; D012007:Rectum / Q000503:physiopathology; D012189:Retrospective Studies
chemical_list: D002245:Carbon Dioxide