Chapter 4 - Neurologic Complications of Congenital Heart Disease and Cardiac Surgery in Children

Abstract

Neurologic morbidity, often coupled with lifelong neurodevelopmental adversity, has become increasingly recognized among survivors of congenital heart disease. Previously, neurologic complications were mostly mediated by chronic hypoxia and polycythemia in cyanotic children, uncorrected right-to-left shunts, and the effects of repeated palliative heart operations. Advances in surgical technique and intensive care management have allowed the anatomic correction of many heart lesions in early infancy, and neurologic sequelae are now increasingly seen in adult survivors of congenital heart disease. The same surgical support techniques responsible for advancing survival have paradoxically been associated with an incidence of neurologic complications including stroke, seizures, and delayed recovery of consciousness that approaches 25 percent in some centers. Both acquired and developmental brain disturbances in infants with congenital heart disease may also have their origin prior to surgical intervention, in many cases during the fetal period. This chapter addresses preoperative, intraoperative, and postoperative neurologic abnormalities in children with congenital heart disease.