Frequency and outcome of acute neurologic complications after congenital heart disease surgery

Jafri, Sidra Kaleem; Ehsan, Lubaina; Abbas, Qalab; Ali, Fatima; Chand, Prem; Haque, Anwar Ul

doi:10.4103/jpn.jpn_87_17

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…Jafri et al reported that 35 (1.75%) of the 2000 pediatric cardiac surgery patients they evaluated developed acute neurological complications, and 28 of those 35 patients (80%) presented clinical signs of seizure [ 4 ]. Of the 3849 patients who underwent surgery, 162 had neurological complications in the early period, comprising a rate of 4.2% in our patient group; 42.6% of these 162 patients ( n = 69) had seizures, 10.5% ( n = 17) had confusion, 24.1% ( n = 39) had stupor symptoms, and 22.8% ( n = 37) demonstrated symptoms of hemiparesis.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative neurological problems are also seen in children with congenital heart disease, regardless of surgical complications. It should be kept in mind that abnormal brain development, chromosomal and genetic anomalies, and sequelae such as thin and coarse motor deficits secondary to previous medical interventions, attention deficit hyperactivity disorder, and speech and language disorders may develop [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Neurological complications after pediatric cardiac surgery

et al. 2021

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Background The number of pediatric patients who survive open-heart surgery has increased in recent years and the complications seen in this patient group continue to decrease with each technological advance, including new surgical and neuroprotective techniques and the improvement in surgeons’ experience with this patient population. However, neurological complications, which are the most feared and difficult to manage, require long-term follow-up, and increase hospital costs remain a leading cause of mortality and morbidity in this cohort. Results We evaluated the neurological physical examination, cranial computed tomography (CT), and magnetic resonance (MRI) records of 162 pediatric patients with neurological symptoms lasting more than 24 h after undergoing heart surgery in our clinic between June 2012 and May 2020. The patients’ ages ranged from 0 to 205 months, with a mean of 60.59 ± 46.44 months. Of the 3849 pediatric cardiac surgery patients we screened, 162 had neurological complications in the early period (the first 10 days after surgery). The incidence was calculated as 4.2%; 69 patients (42.6%) experienced seizures, 17 (10.5%) experienced confusion, 39 (24.1%) had stupor, and 37 (22.8%) had hemiparesis. Of the patients who developed neurological complications, 54 (33.3%) died. Patients with neurological complications were divided into 3 groups: strokes (n = 90), intracranial bleeding (n = 37), and no radiological results (n = 35). Thirty-four patients (37.8%) in the stroke group died, as did 15 (40%) in the bleeding group, and 5 (14.3%) in the no radiological results group. Conclusions Studies on neurological complications after pediatric heart surgery in the literature are currently insufficient. We think that this study will contribute to a more detailed discussion of the issue. Responses to neurological events and treatment in the pediatric group may differ compared to the adult age group. Primary prevention methods should be the main approach in combating neurological complications; their formation mechanisms should be carefully monitored and preventive treatment strategies should be developed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurological complications after pediatric cardiac surgery

et al. 2021

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“…Congenital heart disease is a further reason for critical illness in early infancy in up to 0.8 % of livebirth. Survival improved due to early heart surgery but there is a significant burden of neurodevelopmental deficits: Acute neurologic complications in children undergoing congenital heart surgery occur in 1.75% patients in a recent retrospective study and are related to hypoxia, brain bleeding or embolism [23]. The cumulative incidence rates of attention deficit (hyperactivity) disorder and autism spectrum disorder were even higher in children with congenital heart disease than in a control group (4.55 vs. 1.26/1000 person years for attention deficit hyperactivity disorder and 0.99 vs.0.2/1000 person-years for autism spectrum disorder) [24].…”

Section: Hyothermia and Hrvmentioning

confidence: 99%

Early Life Stress, Growth and Neurodevelopment in Childhood

Buchhorn¹

2020

MRAJ

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Follow up studies of children with congenital heart disease, premature birth, small for gestational age syndrome and attention deficit hyperactivity disorder show significantly reduced 24-hours heart rate variability (HRV) that indicate autonomic dysfunction. The underlying pathophysiological process is of high clinical importance if autonomic dysfunction in these children is related to neurocognitive impairment, an enhanced cardiovascular risk, and a higher risk of short stature. Elevated norepinephrine levels, reduced HRV and MRI imaging indicate brain injury very early in life. We introduce the term autonomic imprinting to explain how early life stress have a lifelong imprinting effect on the autonomic nervous system. Many efforts are done for a careful management of infants in pediatric intensive care units. However, early life stress cannot be prevented if sympathetic activation is part of the underlying disease most of all due to congestive heart failure. We could demonstrate that beside a careful management, pharmacotherapy has a high impact on autonomic dysfunction in children with heart failure, attention deficit disorder and short stature. Moreover, online HRV monitoring is a complete noninvasive tool to monitor early life stress if it uses the data from routine heart rate monitoring. HRV online monitoring on the pediatric intensive care unit and Holter ECG monitoring in a daily life setting are clinical routine in our department for each pharmacotherapy affecting the autonomic nervous system. In the same time as monitoring of early life stress becomes clinically routine, the situation of children will improve if we realize which interventions increase early life stress or improve its detrimental damages in longtime follow up.

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“…As per neuroimaging and psychological evaluations, the surveys suggest that cardiac anomalies can precipitate impaired neurocognitive function. It is marked by changes in multiple areas, including diminished brain power, an increased risk of seizure or stroke, and an altered level of consciousness (ALOC), 7 , or diminishing IQ as a result of chronic or prolonged hypoxia and cyanotic lesions. However, our point of focus in this study is the outcome of attention-deficit/hyperactivity disorder (ADHD) as a late complication in CHD patients.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Attention-Deficit Hyperactivity Disorder (ADHD) in Patients with Congenital Heart Diseases (CHD) at NICVD Karachi, Pakistan

Memon¹,

Maheshwari²,

Ashfaq³

et al. 2023

PJMHS

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Background: The study aimed to assess the frequency and impact of attention-deficit hyperactivity disorder (ADHD) on behavior, social-emotional development, intelligence, and overall quality of life among school-aged children with congenital heart diseases (CHD). Methodology: A descriptive cross-sectional study was undertaken at the National Institute of Cardiovascular Diseases (NICVD) between July 2021 to August 2021. A total of 100 CHD patients aged 6 to 18 were assessed using the non-probability purposive sampling technique. The data was collected using a questionnaire comprising SNAP-IV 26 Scale that is a screening tool for ADHD. The collected data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) v 24.0. The statistical analysis was carried out with a confidence interval set at 95% and no p-value was determined as a threshold of statistical significance, owing to the qualitative nature of the data. Result: The study comprises n=100 CHD patients, aged 6 to 18 with the mean age ± standard deviation of 11.18 ± 3.914, and males and females stratifiable into 56% and 44% respectively. The ADHD screening identified n=22 (22%) subjects as highly suspected of having ADHD with no statistically significant gender difference (n=10 females vs. n=12 males). The study revealed Ventricular Septal Defect (VSD) to be the most common (28%) congenital heart defect across the in-patient and out-patient settings. VSD is followed by Atrial Septal Defect (ASD) at 24%, Tetralogy of Fallot (TOF) at 22%, Atrioventricular Septal Defect (AVSD) at 19%, and Aortic Stenosis (AS) in 7% of the patients. Out of the 25% facing comorbidities, hypertension dominated the subset of 23%. Conclusion: This study suggests that children with CHD are at an increased risk of developing ADHD, the hyperactive and the combined subtype in particular, compared to the healthy population. About 22 percent of the subjects manifested a typical clinical picture of an ADHD patient with mostly living a ‘somewhat difficult’ life. Keywords: Children, Congenital Heart Disease, CHD, Attention-Deficit Hyperactivity Disorder, ADHD, Ventricular Septal Defect, VSD, Atrial Septal Defect, ASD

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Frequency and outcome of acute neurologic complications after congenital heart disease surgery

Cited by 11 publications

References 15 publications

Neurological complications after pediatric cardiac surgery

Neurological complications after pediatric cardiac surgery

Early Life Stress, Growth and Neurodevelopment in Childhood

Frequency of Attention-Deficit Hyperactivity Disorder (ADHD) in Patients with Congenital Heart Diseases (CHD) at NICVD Karachi, Pakistan

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