title: Should what we know about neurobehavioral development, complex congenital heart disease, and brain maturation affect the timing of corrective cardiac surgery?
abstract: Despite remarkable improvements in perioperative care, adverse neurobehavioral outcomes following neonatal and infant cardiac surgery are commonplace and are associated with substantial morbidity. It is becoming increasingly clear that complex congenital heart disease is associated with both abnormalities in neuroanatomic development and a delay in fetal brain maturation. Substantial cerebral ischemic/hypoxic injury has been detected in neonates with complex congenital heart disease both prior to and following corrective cardiac surgery. The brain of the neonate with complex congenital heart disease appears to be uniquely vulnerable to the types of ischemic/hypoxic injury associated with perioperative care. It remains to be determined whether delaying surgical correction to allow for brain maturation will be associated with improvements in neurobehavioral outcomes.
authors.affiliation: Children's Hospital Boston, Department of Anesthesiology, Boston, MA 02115, USA. james.dinardo@childrens.harvard.edu
authors.forename: James A
authors.initials: JA
authors.lastname: DiNardo
mesh_terms: D001921:Brain / Q000254:growth & development*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002648:Child; D002652:Child Behavior; D002657:Child Development; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009420:Nervous System / Q000098:blood supply / Q000254:growth & development*; D009421:Nervous System Malformations / Q000150:complications; D010372:Pediatrics / Q000592:standards*; D011296:Prenatal Diagnosis; D012039:Regional Blood Flow; D013903:Thoracic Surgery / Q000592:standards*