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Ann Thorac Surg 2002;73:1752-1758
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Current incidence of acute neurologic complications after open-heart operations in children

Caroline C. Menache, MDa, Adré J. du Plessis, MBChBa, David L. Wessel, MDb, Richard A. Jonas, MD*c, Jane W. Newburger, MDb

a Department ofNeurology, Boston, Massachusetts, USA
b Department ofCardiology, Boston, Massachusetts, USA
c Department ofCardiovascular Surgery, Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Accepted for publication February 15, 2002.

* Address reprint requests to Dr du Plessis, Department of Neurology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA
e-mail: adre.duplessis{at}tch.harvard.edu

Background. Previously, neurologic dysfunction was estimated to complicate 25% or less of pediatric open-heart operations. We sought to determine the current incidence and spectrum of early postoperative neurologic complications.

Methods. We undertook a retrospective review of all patients undergoing open heart operations in 1 year at our institution with the goal to identify all neurologic complications occurring in the early postoperative period.

Results. Open-heart operations were performed in 706 children. Sixteen children (2.3%) had neurologic complications develop, including 9 (1.3%) with definite clinical seizures, 1 with suspected seizures and bilateral subdural hemorrhage, 2 with coma after cardiac arrest, 2 with transient mild choreoathetosis, 1 with facial palsy, and 1 with persistent irritability. Causes of seizure were cyclosporin A toxicity posttransplant (4), cerebral ischemia post cardiac arrest (3), and unknown (2). In infants less than 1 year of age, the incidence of seizures was 1.2%.

Conclusions. This review suggests a decrease in acute neurologic morbidity after pediatric open heart operation. Clinical seizures remain the most common complication. Posttransplant, cyclosporin-associated seizures have emerged as an important etiologic category, coincident with an increase in cardiac transplantation in children.




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