Perioperative stroke in infants undergoing open heart operations for congenital heart disease.
BACKGROUND
The prevalence of perioperative stroke in infants undergoing operations for congenital heart disease has not been well described. The objectives of this study were to determine the prevalence of stroke as assessed by postoperative brain magnetic resonance imaging (MRI), characterize the neuroanatomic features of focal ischemic injury, and identify risk factors for its development.


METHODS
Brain MRI was performed in 122 infants 3 to 14 days after cardiac operation with cardiopulmonary bypass, with or without deep hypothermic circulatory arrest. Preoperative, intraoperative, and postoperative data were collected. Risk factors were tested by logistic regression for univariate and multivariate associations with stroke.


RESULTS
Stroke was identified in 12 of 122 patients (10%). Strokes were preoperative in 6 patients and possibly intraoperative or postoperative in the other 6 patients, and were clinically silent except in 1 patient who had clinical seizures. Arterial-occlusive and watershed infarcts were identified with equal distribution in both hemispheres. Multivariate analysis identified lower birth weight, preoperative intubation, lower intraoperative hematocrit, and higher blood pressure at admission to the cardiac intensive care unit postoperatively as significant factors associated with stroke. Prematurity, younger age at operation, duration of cardiopulmonary bypass, and use of deep hypothermic circulatory arrest were not significantly associated with stroke.


CONCLUSIONS
The prevalence of stroke in infants undergoing operations for congenital heart disease was 10%, half of which occurred preoperatively. Most were clinically silent and undetected without neuroimaging. Mechanisms included thromboembolism and hypoperfusion, with patient-specific, procedure-specific, and postoperative contributions to increased risk.
Chen
Jodi
J
Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. chenjo@email.chop.edu
Zimmerman
Robert A
RA
Jarvik
Gail P
GP
Nord
Alex S
AS
Clancy
Robert R
RR
Wernovsky
Gil
G
Montenegro
Lisa M
LM
Hartman
Diane M
DM
Nicolson
Susan C
SC
Spray
Thomas L
TL
Gaynor
J William
JW
Ichord
Rebecca
R
D001921:Brain / Q000473:pathology; D002315:Cardiopulmonary Bypass; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003430:Cross-Sectional Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D010414:Pennsylvania; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors
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