title: Perioperative stroke in infants undergoing open heart operations for congenital heart disease.
abstract: 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.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. chenjo@email.chop.edu
authors.forename: Jodi
authors.initials: J
authors.lastname: Chen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zimmerman
authors.forename: Gail P
authors.initials: GP
authors.lastname: Jarvik
authors.forename: Alex S
authors.initials: AS
authors.lastname: Nord
authors.forename: Robert R
authors.initials: RR
authors.lastname: Clancy
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Montenegro
authors.forename: Diane M
authors.initials: DM
authors.lastname: Hartman
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
mesh_terms: 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
references.citation: J Cardiothorac Vasc Anesth. 1996 Jan;10(1):66-74
references.pmid: 8634389
references.citation: Pediatrics. 1999 Feb;103(2):402-8
references.pmid: 9925832
references.citation: Cardiol Young. 2006 Feb;16 Suppl 1:92-104
references.pmid: 16401370
references.citation: Clin Perinatol. 2005 Dec;32(4):921-46, ix
references.pmid: 16325670
references.citation: J Thorac Cardiovasc Surg. 2003 Dec;126(6):1736-45
references.pmid: 14688681
references.citation: J Thorac Cardiovasc Surg. 2007 Jan;133(1):29-36
references.pmid: 17198777
references.citation: J Thorac Cardiovasc Surg. 2003 Dec;126(6):1765-74
references.pmid: 14688685
references.citation: Am J Perinatol. 1996 Jan;13(1):47-53
references.pmid: 8645386
references.citation: Pediatrics. 1990 Jun;85(6):991-1000
references.pmid: 2339048
references.citation: Brain Dev. 1992 Nov;14(6):381-5
references.pmid: 1492650
references.citation: N Engl J Med. 1995 Mar 2;332(9):549-55
references.pmid: 7838188
references.citation: J Thorac Cardiovasc Surg. 2005 Dec;130(6):1523-30
references.pmid: 16307993
references.citation: Stroke. 2007 Feb;38(2 Suppl):736-41
references.pmid: 17261728
references.citation: J Thorac Cardiovasc Surg. 2004 Mar;127(3):692-704
references.pmid: 15001897
references.citation: Nat Genet. 1994 Jun;7(2):180-4
references.pmid: 7920638
references.citation: Circulation. 2002 Sep 24;106(12 Suppl 1):I109-14
references.pmid: 12354718
references.citation: J Thorac Cardiovasc Surg. 2000 Feb;119(2):347-57
references.pmid: 10649211
references.citation: Chest. 1999 Sep;116(3):740-7
references.pmid: 10492281
references.citation: Circulation. 1999 Aug 3;100(5):526-32
references.pmid: 10430767
references.citation: Ann Thorac Surg. 1997 Sep;64(3):715-20
references.pmid: 9307463