Open Access Maced J Med Sci. 2021 Jan 31; 9(B):137-143. 137
Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia
Open Access Macedonian Journal of Medical Sciences. 2021 Jan 31; 9(B):137-143.
https://doi.org/10.3889/oamjms.2021.5581
eISSN: 1857-9655
Category: B - Clinical Sciences
Section: Cardiology
Neurological Sequelae Following Pediatric Cardiac Interventions
Hala Mounir Agha
1
, Mai Mahmoud Hussien
2
*, Marian Y Girgis
3
, Omneya Gamal Eldin Affy
3
, Mervat Ahmed Haroun
3
1
Department of Pediatrics, Pediatric Cardiology Division, Specialized Pediatric Hospital, Cairo University;
2
Department of
Pediatrics, National institute of neuromotor system, General organization of Teaching hospitals and Institutes;
3
Department of
Pediatrics, Pediatric Neurology Division, Specialized Pediatric Hospital, Cairo University
Abstract
PURPOSE: The aim of the present study was to assess neurological sequelae within 30 days of surgical or cardiac
catheter interventions in infants and children.
METHOD: In this cross-sectional study, we evaluated all patients who developed neurological problems after cardiac
interventions either by surgery or by catheter by clinical evaluation, brain imaging, and electrophysiological studies.
RESULTS: Among 1200 procedures were performed; 895 (74.6%) were cardiac catheterizations either diagnostic
or intervention, 167 (13.9%) were open-heart surgery, and 138 (11.5%) were closed heart surgery. The overall
incidence of post-procedure neurological dysfunction in the studied population was 3.4%. The diferences between
the three groups were statistically signifcant (p < 0.0001(. In our series, the neurological complications were in the
form of disturbed conscious level in 2/41 (4.9%), impaired motor function in 11/41 (26.8%), impaired mental functions
in 6/41(14.6%), hyperrefexia in 27/41 (65.9%), and seizures in 38/41 (92.7%). The most common presentation of
seizures was in the form of focal fts 21/41 (51.2%), followed by generalized fts in 15/41(36.6%) and then myoclonic
fts 2/41 (4.9%).
CONCLUSION: Seizures are the most common complication following cardiac interventions in pediatric age and the
highest percentage following open heart surgery.
Edited by: https://publons.com/researcher/391987/
mirko-spiroski/
Citation: Agha HM, Hussien MM, Girgis MY, Affy OGE,
Mervat Ahmed Haroun. Neurological Sequelae Following
Pediatric Cardiac Interventions. Open Access Maced J
Med Sci. 2021 Jan 31; 9(B):137-143.
https://doi.org/10.3889/oamjms.2021.5581
Keywords: Congenital heart; Neurological insult; Open
surgery; Closed surgery; Catheterization
*Correspondence: Mai Mahmoud Hussien, Department
of Pediatrics, National institute of neuromotor system,
General organization of Teaching hospitals and Institutes.
E-mail: mhussien1001@gmail.com
Received: 19-Nov-2020
Revised: 22-Dec-2020
Accepted: 21-Jan-2021
Copyright: © 2020 Hala Mounir Agha,
Mai Mahmoud Hussien, Marian Y Girgis,
Omneya Gamal Eldin Affy, Mervat Ahmed Haroun
Funding: This research did not receive any fnancial
support
Competing Interests: The authors have declared that no
competing interests exist.
Open Access: This is an open-access article distributed
under the terms of the Creative Commons Attribution-
NonCommercial 4.0 International License (CC BY-NC 4.0)
Introduction
Congenital heart diseases (CHDs) are one of
the most common congenital defects being responsible
for multitude of complications despite the recent surgical
and interventional techniques improvements [1].
The mortality rate is increased in complex conditions
associated with heart failure, respiratory failure, or shock.
Indeed, the mortality rate reported by several centers is
around 6% in children compared to 3% in adults [2].
Recent evidence suggests that recent
therapeutic interventions aimed at minimizing
progressive organ function deterioration, especially the
brain, might be as well helpful in reducing in-hospital
mortality and improving neurological outcome as well as
quality of life after cardiac arrest insults [3]. Circulatory
arrest during cardiac surgery is often associated
with a great risk of postoperative neurological defcit
with strokes in adults and seizures in children being
the most common neurological complication after a
cardiac surgery [4]. Early-onset seizures are common
manifestation in children aficted with arterial ischemic
strokes, yet their clinical features and outcomes have
been understudied [5]. Recently, there have been
several retrospective reports suggesting an increase
in seizures frequency post-cardiopulmonary bypass
entailing increased patient morbidity [6]. A longstanding
concern about cerebral injury potential in infants after
heart surgery had been raised. The post-operative
cognitive function evaluation of such patients has
consistently demonstrated neurological impairment
defcits, the etiology of which appears to be multifactorial
and a growing need for better understanding is
warranted. Variety of techniques had been used to gain
insight into early neurological injury. Those techniques
included electroencephalography brain isoenzymes
and cerebral metabolism measurements. Brain imaging
studies can also play a key role in mapping the extent
and nature of the neurological insult [7]. The aim of this
current work is to identify neurological complications
within 30 days following pediatric cardiac interventions
may it be through surgery or catheterization.
Patients and Methods
This study was a cross-section analytical study
conducted at Cairo University Specialized Pediatric
Hospital, Faculty of Medicine, in the period from January