Incidence and Prognosis of Seizures in Infants After Cardiac Surgery With Profound Hypothermia and Circulatory Arrest

Abstract

Fifteen of 165 infants and young children who underwent surgical correction of congenital cardiac defects using profound hypothermic and circulatory arrest experienced generalized or focal seizures postoperatively. The cause of the seizures was unexplained in ten. Among these ten, the onset of seizures was 25 to 48 hours after surgery. With appropriate treatment, all had complete seizure control by the third postoperative day. During 11 to 54 months (mean, 35.6 months) of follow-up, no further seizures occurred and none had neurological abnormalities. Long-term anticonvulsant therapy was not required for any of the children. There was no correlation between the type of cardiac abnormality (cyanotic v acyanotic) or the duration of hypothermic circulatory arrest and the development of seizures. Unexplained seizures following cardiac surgery with hypothermia and circulatory arrest are not a sign of permanent brain damage and do not detract from the use of this technique for early definitive repair of congenital heart defects.

Phentolamine administration increases blood S100B protein levels in pediatric open-heart surgery patients

“…Recently, in children supported by extracorporeal membrane oxygenation after congenital heart disease repair developing cerebral hemorrhage, S100B blood levels showed a similar trend to those found in the present study (27). Although all the infants treated with phentolamine were neurologically normal on discharge from the hospital, the possibility of longterm neurological abnormalities in these patients should be taken into account (1,2).…”

“…Despite the use of cerebral protection strategies such as hypothermic cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), about 25% of infant heart surgery procedures can still be complicated by adverse neurological events (1,2). Vasoconstriction and increased vascular resistance, resulting in uneven regional organ perfusion, are among the undesired side effects of CPB (3,4).…”

Intraoperative Electroencephalography Predicts Postoperative Seizures in Infants With Congenital Heart Disease

“…The incidence of clinically apparent post-operative seizures in infants with complicated cardiac defects requiring surgery is 4–10% 1,2 . Further, when postoperative continuous EEG monitoring is used, seizure frequency increases to 26%.…”

Cardiac surgery in the young infant: An in vivo model for the study of hypoxic-ischemic brain injury?

“…injury at a cerebral level. The most common acute presentations of cerebral injury include seizures [Ehyai et al, 1984;Newburger et al, 1993], movement disorders [Robinson et al, 1988;Wong et al, 1992;Huntley et al, 1993;Curless et al, 1994], and stroke [Terplan 1973[Terplan , 1976Mathews et al, 1986;Moody et al, 1990;Hutto et al, 1991;Boyajian et al, 1993;du Plessis et al, 1995a;Rosenthal et al, 1995]. Chronic sequelae include motor, cognitive, and behavioral impairment [Stevenson et al, 1974;Wright et al, 1979;Wells et al, 1983;du Plessis et al, 1994a;Bellinger et al, 1995].…”

“…Seizures are the most common manifestation of cerebral dysfunction in the early postoperative period, manifesting clinically in up to 15% of infants [Brunberg et al, 1974b;Clarkson et al, 1980;Ehyai et al, 1984;Newburger et al, 1993;Miller et al, 1995]. Electrographic seizures, diagnosed by continuous electroencephalogram video (EEG) monitoring, may occur during the early period after DHCA in up to 26% of infants [Newburger et al, 1993].…”