Related Experiment Videos
Neurologic complications of pediatric heart transplantation
B J Lynch1, T A Glauser, C Canter
1Department of Neurology, St Louis Children's Hospital, Washington University School of Medicine, Mo.
Insights
Pediatric heart transplantation offers high survival rates with a low incidence of severe acquired neurological complications. This study found only one patient with a significant neurological deficit after the procedure.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Transplantation Medicine
Background:
- Pediatric heart transplantation (HT) is a critical intervention for end-stage heart disease in children.
- Understanding the neurological outcomes post-HT is essential for comprehensive patient care.
- Previous data on acquired neurological complications in pediatric HT survivors is limited.
Purpose of the Study:
- To determine the type and frequency of acquired neurological complications in survivors of pediatric heart transplantation (HT).
- To evaluate neurological outcomes in different pediatric patient subgroups undergoing HT.
Main Methods:
- Retrospective study design.
- Analysis of 17 consecutive pediatric patients undergoing HT between January 1986 and December 1990.
- Neurological assessments and clinical data review for survivors.
Main Results:
- A high survival rate of 82% (14 out of 17 patients) was observed at follow-up.
- Only one patient (7%) experienced a significant acquired neurological deficit (stroke with seizures).
- Minor neurological abnormalities (dysmetria, tremor, absent reflexes) were noted in some survivors; no choreoathetosis or cyclosporine-related seizures were observed.
Conclusions:
- Pediatric HT is associated with a high survival rate and a low incidence of severe acquired neurological deficits.
- Despite pre- and post-transplant systemic and metabolic derangements, severe neurological morbidity is infrequent.
- In infants with hypoplastic left heart syndrome (HLHS), HT may offer a lower incidence of severe neurological morbidity compared to other surgical treatments.
Objective:
To determine the type and frequency of acquired neurologic complications in survivors of pediatric heart transplantation (HT).
Design:
Retrospective study.
Setting:
Tertiary care children's hospital.
Participants:
Fourteen survivors of 17 consecutive patients who underwent HT during a 60-month period beginning in January 1986.
Interventions:
None. MEASUREMENTS OR MAIN RESULTS: Three distinct subgroups of patients who had undergone HT were identified: six infants with uncorrected hypoplastic left heart syndrome (HLHS), three infants with HLHS who had undergone previous stage 1 Norwood repair, and eight older children with end-stage cardiomyopathy. Fourteen (82%) of 17 children were alive at follow-up. Only one patient (7%) had a significant acquired neurologic deficit (left temporal lobe stroke with subsequent seizures in an infant with uncorrected HLHS). The remaining subjects had normal results of post-HT neurologic examinations (n = 7), minor post-HT neurologic abnormalities (n = 3), no significant change in preexisting neurologic abnormalities (n = 1), or normal neurologic status by report (n = 2). The minor neurologic abnormalities noted post-HT were dysmetria, tremor, and absent reflexes. No episodes of choreoathetosis or cyclosporine-related seizures were seen.
Conclusions:
Pediatric HT is associated with both a high survival rate and a low incidence of severe acquired neurologic deficits despite a significant incidence of severe systemic and metabolic derangements in the pretransplantation and posttransplantation periods. In infants with HLHS, HT seems to carry a lower incidence of severe neurologic morbidity (12%) than other surgical treatments.