Short term Neurological Complications After Surgical Correction in Children with Congenital Heart Disease: A Single Center Study

Abstract

: Background: Congenital heart disease represents a common type of birth defects. Cardiac surgery required for correction of these congenital anomalies may result in multiple neurological complications during or after surgery either transient or permanent. Aim of the Work: To determine the frequency and the outcome of the short term neurological complications in children undergoing congenital heart disease surgery. Patients and Methods: An observational prospective study was conducted in the postoperative cardiac Pediatric Intensive Care Unit (PICU) in Cairo University Children Hospital. It included 105 patients from 1 month to 12 years who underwent surgery for correction of the congenital heart disease. Follow up of the patients who developed neurological complications for 3 months post discharge from PICU was done to assess the outcome. Results: 16 patients (15.2%) developed acute neurological complications. Seizures were in 11 patients, 3 of them had associated disturbed conscious level (DCL) and stroke. Delayed recovery of consciousness was found in 6 patients, 5 of them were associated with seizures. Intensive care unit acquired weakness (ICUAW) was reported in 5 patients. Five patients with seizures were discharged, 3 of them with regressive course post discharge where seizures were controlled on a single antiepileptic drug (AED) and the other 2 with progressive course that necessitated addition of another AED. Four patients with ICUAW had regressive course post discharge. Conclusion: Acute neurological complications post congenital heart diseases surgery are serious morbidities and are associated with high risk of mortality. Primary prevention of these complications by using neuroprotective measures and avoiding the development of shock, and infection beside reduction of hospital stay can be helpful in decreasing incidence of complications and improving outcome among those patients. Nerve conduction velocity (NCV) and electromyography (EMG) were performed in cases of peripheral nervous system affection by neurophysiology using a Select For the nerve conduction studies, surface electrodes were used. The motor and the sensory nerve conduction velocity (CV) meter/second [m/s], distal motor latency (DML) [in milliseconds], compound muscle action potential (CMAP) amplitudes [mV] and sensory nerve action potential (SNAP) amplitudes in millivolts [µV] were recorded. EMG was recorded using a coaxial needle electrode in the tibialis anterior, quadriceps femoris, abductor pollicis brevis, and deltoid additional were studied in some patients.