Perioperative stroke in infants undergoing open heart operations for congenital heart disease.
Ann Thorac Surg
; 88(3): 823-9, 2009 Sep.
Article
em En
| MEDLINE
| ID: mdl-19699905
ABSTRACT
BACKGROUND:
The prevalence of perioperative stroke in infants undergoing operations for congenital heart disease has not been well described. The objectives of this study were to determine the prevalence of stroke as assessed by postoperative brain magnetic resonance imaging (MRI), characterize the neuroanatomic features of focal ischemic injury, and identify risk factors for its development.METHODS:
Brain MRI was performed in 122 infants 3 to 14 days after cardiac operation with cardiopulmonary bypass, with or without deep hypothermic circulatory arrest. Preoperative, intraoperative, and postoperative data were collected. Risk factors were tested by logistic regression for univariate and multivariate associations with stroke.RESULTS:
Stroke was identified in 12 of 122 patients (10%). Strokes were preoperative in 6 patients and possibly intraoperative or postoperative in the other 6 patients, and were clinically silent except in 1 patient who had clinical seizures. Arterial-occlusive and watershed infarcts were identified with equal distribution in both hemispheres. Multivariate analysis identified lower birth weight, preoperative intubation, lower intraoperative hematocrit, and higher blood pressure at admission to the cardiac intensive care unit postoperatively as significant factors associated with stroke. Prematurity, younger age at operation, duration of cardiopulmonary bypass, and use of deep hypothermic circulatory arrest were not significantly associated with stroke.CONCLUSIONS:
The prevalence of stroke in infants undergoing operations for congenital heart disease was 10%, half of which occurred preoperatively. Most were clinically silent and undetected without neuroimaging. Mechanisms included thromboembolism and hypoperfusion, with patient-specific, procedure-specific, and postoperative contributions to increased risk.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Recém-Nascido de Baixo Peso
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Imageamento por Ressonância Magnética
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Ponte Cardiopulmonar
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Infarto Cerebral
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Embolia Intracraniana
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Parada Circulatória Induzida por Hipotermia Profunda
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Cardiopatias Congênitas
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Doenças do Prematuro
Tipo de estudo:
Etiology_studies
/
Observational_studies
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Prevalence_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Female
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Humans
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Infant
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Male
/
Newborn
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2009
Tipo de documento:
Article