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Transient cortical blindness after heart surgery in a child patient -A case report-
Young Duck Shin1, Seung Woon Lim, Jin Ho Bae
1Department of Anesthesiology and Pain Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea.
Insights
Pediatric cardiac surgery using cardiopulmonary bypass (CPB) can cause rare but serious visual loss. This case study details a transient visual impairment in a child following tricuspid valve surgery, linked to an occipital lobe infarct.
Area of Science:
- Pediatric Cardiology
- Neurology
- Ophthalmology
Background:
- Postoperative visual loss is a rare but significant complication following pediatric cardiac surgery with cardiopulmonary bypass (CPB).
- Potential causes include CPB-related micro-embolization, inflammatory vascular changes, hemodilution, and hypothermia affecting cerebral perfusion and oxygen delivery.
Purpose of the Study:
- To report a case of immediate, transient postoperative visual loss in a pediatric patient undergoing cardiac surgery.
- To investigate the potential neurovascular mechanisms contributing to visual impairment in this context.
Main Methods:
- A case report of a 21-month-old male undergoing tricuspid valve surgery.
- Intraoperative monitoring of perfusion pressure.
- Postoperative computed tomography (CT) scan to assess for cerebral injury.
Main Results:
- The patient experienced immediate, transient visual loss post-surgery.
- Postoperative CT revealed a subacute infarct in the occipital lobe.
- Visual recovery commenced on postoperative day 28, with full restoration by day 31.
Conclusions:
- Transient visual loss after pediatric cardiac surgery can occur despite adequate intraoperative perfusion.
- Cerebral infarction, particularly in the occipital lobe, is a potential cause of such visual disturbances.
- Prompt recognition and monitoring are crucial for managing visual complications in pediatric cardiac surgery patients.
Abstract:
Visual loss occurring after pediatric cardiac surgery employing cardiopulmonary bypass (CPB) is relatively rare but the risk is substantial. Compromised cerebral perfusion due to a CPB related micro-embolization and inflammatory vascular changes as well as reduced oxygen carrying capacity in hemodilution and hypothermia during CPB might be major contributing factors to the development of postoperative visual loss after cardiac surgery with CPB. A case of immediate but transient postoperative visual loss was encountered in a 21-month-old male who underwent tricuspid valve surgery. Despite routine intraoperative measures to maintain an adequate perfusion pressure throughout the procedure, postoperative computed tomography revealed a subacute infarct in his occipital lobe. Recovery began on postoperative day 28, and the patient's vision was restored by 31 days.
