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J. William Gaynor
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J Thorac Cardiovasc Surg 2006;131:181-189
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

The relationship of postoperative electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery

J. William Gaynor, MD a , * , Gail P. Jarvik, MD, PhD b , Judy Bernbaum, MD c , Marsha Gerdes, PhD d , Gil Wernovsky, MD e , Nancy B. Burnham, RN, MSN a , Jo Ann D'Agostino, CRNP c , Elaine Zackai, MD f , Donna M. McDonald-McGinn, MS, CGC f , Susan C. Nicolson, MD g , Thomas L. Spray, MD a , Robert R. Clancy, MD h

a Division of Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
c Division of General Pediatrics, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
d Division of Psychology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
e Division of Pediatric Cardiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
f Division of Genetics, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
g Division of Cardiothoracic Anesthesiology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
h Division of Neurology, The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, Pa
b Department of Medicine (Medical Genetics), University of Washington, Seattle, Wash.

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 8, 2005; revisions received May 26, 2005; accepted for publication August 8, 2005.

* Address for reprints: J. William Gaynor, MD, Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Suite 8527, Philadelphia, PA 19104. (Email: gaynor{at}email.chop.edu).

OBJECTIVE: The occurrence of a seizure after the arterial switch operation is associated with a worse long-term neurodevelopmental outcome. The significance of seizures after neonatal and infant repair of other congenital heart defects is not known.

METHODS: A recent study at our institution demonstrated seizures documented by 48-hour electroencephalographic monitoring in 20 (11%) of 178 neonates and infants after surgery for complex congenital heart defects, including hypoplastic left heart syndrome or variants. The developmental outcomes of this cohort were evaluated at 1 year of age by using the Bayley Scales of Infant Development II, which yields 2 scores: the Mental Developmental Index and the Psychomotor Developmental Index.

RESULTS: Developmental evaluations were performed in 114 (70%) of 164 survivors, including 36 with hypoplastic left heart syndrome. Postoperative electroencephalographic seizures had occurred in 15 (13%) of 114 of the entire group and in 8 (22%) of 36 of those with hypoplastic left heart syndrome. For the entire cohort, the Mental Developmental Index was 92.3 ± 13.5, and the Psychomotor Developmental Index was 79.9 ± 18.8 for patients without seizures, compared with 90.3 ± 10.7 and 74.4 ± 19.3 for those with seizures (both P > .5). For the hypoplastic left heart syndrome subgroup, the Mental Developmental Index was 92.3 ± 14.9, and the Psychomotor Developmental Index was 74.8 ± 19.3 for patients with seizures, compared with 91.9 ± 12.4 and 73.9 ± 18.3 for those without seizures (both P > .5). A frontal onset of seizures was predictive of a lower score on the Psychomotor Developmental Index, but not on the Mental Developmental Index.

CONCLUSIONS: The occurrence of a seizure after cardiac operation is a marker of central nervous system injury. However, in this cohort of neonates and infants with complex congenital heart defects, the occurrence of a seizure was not predictive of a worse developmental outcome at 1 year of age as assessed by the Bayley Scales of Infant Development II.

Abbreviations and Acronyms APOE = apolipoprotein E; CHD = congenital heart defect; CNS = central nervous system; CPB = cardiopulmonary bypass; DHCA = deep hypothermia and circulatory arrest; EEG = electroencephalogram; HLHS = hypoplastic left heart syndrome; MDI = Mental Developmental Index; PDI = Psychomotor Development Index; TGA = transposition of the great arteries; VSD = ventricular septal defect




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