Related Experiment Video
Updated: Sep 30, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Current incidence of acute neurologic complications after open-heart operations in children
Caroline C Menache1, Adré J du Plessis, David L Wessel
1Department of Neurology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Insights
Neurologic complications after pediatric open-heart surgery are now less common, occurring in 2.3% of cases. Clinical seizures are the most frequent issue, with cyclosporin A toxicity emerging as a key cause in transplant patients.
Area of Science:
- Pediatric Cardiac Surgery
- Neurology
- Critical Care Medicine
Background:
- Historically, neurologic dysfunction affected 25% or fewer pediatric open-heart surgery patients.
- The current incidence and range of early postoperative neurologic complications require updated assessment.
Purpose of the Study:
- To determine the current incidence of early postoperative neurologic complications in children undergoing open-heart operations.
- To identify the spectrum and causes of these neurologic complications.
Main Methods:
- Retrospective review of all pediatric patients undergoing open-heart operations over one year.
- Identification of all neurologic complications within the early postoperative period.
Main Results:
- Out of 706 children, 16 (2.3%) experienced neurologic complications.
- Clinical seizures were the most common (1.3%), followed by coma, choreoathetosis, facial palsy, and irritability.
- Causes included cyclosporin A toxicity (4), cerebral ischemia (3), and unknown (2); seizure incidence in infants under 1 year was 1.2%.
Conclusions:
- Acute neurologic morbidity appears to have decreased following pediatric open-heart surgery.
- Clinical seizures remain the primary complication.
- Cyclosporin A-associated seizures have become a significant factor, linked to increased pediatric cardiac transplantation.
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.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:22Aneurysm IV: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:30Introduction Cardiac Emergencies