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Postoperative encephalopathy with choreoathetosis.

Allison Przekop1, Chalmer McClure, Stephen Ashwal

  • 1Division of Pediatric Neurology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92350, USA.

Handbook of Clinical Neurology
|April 19, 2011
PubMed
Summary
This summary is machine-generated.

Survival rates for children with congenital heart defects (CHD) have improved due to advanced surgical techniques. However, this progress is linked to an increase in neurological complications like postpump chorea.

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Area of Science:

  • Pediatric Cardiology
  • Pediatric Neurology
  • Cardiovascular Surgery

Background:

  • Improved survival in children with congenital heart defects (CHD) since the 1980s is attributed to surgical advancements like cardiopulmonary bypass and deep hypothermia.
  • A rise in survival has paralleled an increase in postoperative neurological complications.
  • Postpump chorea, a form of postoperative encephalopathy with choreoathetosis, is a significant and devastating neurological complication following pediatric cardiac surgery.

Purpose of the Study:

  • To explore the etiology and pathophysiology of postpump chorea.
  • To identify factors contributing to the development of choreoathetoid movements post-cardiac surgery.
  • To understand the varying long-term neurological outcomes in children affected by postpump chorea.

Main Methods:

  • Review of existing literature on postpump chorea and associated neurological complications in pediatric cardiac surgery.
  • Analysis of potential contributing factors including deep hypothermia, circulatory arrest, cardiopulmonary bypass, and blood gas variability.
  • Examination of the relationship between age at surgery and the severity of postpump chorea.

Main Results:

  • The exact cause and mechanisms of postpump chorea remain unknown.
  • Factors implicated include deep hypothermia, cardiopulmonary bypass, and fluctuations in cerebral blood flow due to pH and PaCO2 variations.
  • The severity and duration of choreoathetoid movements, and long-term outcomes, differ between mild and severe forms of encephalopathy. Older children may be at higher risk for the severe, persistent form.

Conclusions:

  • Postpump chorea is a serious neurological complication following pediatric cardiac surgery, with unknown etiology.
  • Management and understanding of risk factors like hypothermia and patient age are crucial for improving outcomes.
  • Further research is needed to elucidate the pathophysiology and develop targeted interventions for postpump chorea.