J Thorac Cardiovasc Surg 2006;132:441-442
© 2006 The American Association for Thoracic Surgery
Reply to the Editor
J. William Gaynor, MD
a
,
Gil Wernovsky, MD
b
,
Robert R. Clancy, MD
c
a Division of Pediatric Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104
b Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104
c Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104
We appreciate the comments by Hashmi, Hanif, and O'Reilly concerning our recent article, titled "The Relationship of Postoperative Electrographic Seizures to Neurodevelopmental Outcome at 1 Year of Age After Neonatal and Infant Cardiac Surgery."
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They raised several questions concerning including (1) preoperative seizure history; (2) the lack of seizure activity in patients with transposition of the great arteries (TGA) with a ventricular septal defect (VSD), previously considered a high-risk group for postoperative seizures; (3) duration of seizure activity; and (4) whether or not the electroencephalographic (EEG) examiners were blinded to the fact that the child had a seizure in the postoperative period. The patients in this study were a subset of a larger group of patients who underwent 48-hour EEG monitoring after cardiac surgery. We
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have previously reported outcomes for the larger group, including the incidence of postoperative seizures and risk factors for postoperative seizures. No seizures were identified on the preoperative EEGs in that study and no infant was suspected to have had seizures by clinical observation. Postoperative seizures were most common in patients with hypoplastic left heart syndrome or a variant. EEG seizure activity was identified in only 1 of 12 patients with TGA (with or without VSD). We speculated that the decreasing incidence of postoperative seizures compared with previous reports, particularly among children undergoing biventricular repair, was due to improved (intraoperative and perioperative) management strategies. It is likely that specific anatomic subgroups previously considered to be at high risk for postoperative seizure activity are no longer at increased risk. As Hashmi, Hanif, and O'Reilly note, we did not report duration of seizure activity. However, we did evaluate the number of seizures in the monitoring period as a risk factor for worse neurodevelopmental outcome. The number of seizures was not predictive of scores on either the Mental Developmental Index (MDI) or the Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development-
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Hashmi, Hanif, and O'Reilly also ask whether the EEG examiners were blinded to the fact that the child had a seizure in the postoperative period. As the recent study evaluated neurodevelopmental outcomes, we assume that they do not mean the EEG examiners, but rather the psychologists performing the 1-year neurodevelopmental evaluation, who were blinded to the child's seizure status.
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References
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- Gaynor JW, Jarvik GP, Bernbaum J, Gerdes M, Wernovsky G, Burnham NB, et al. The relationship of postoperative electrographic seizures to neurodevelopmental outcome at 1 year of age after neonatal and infant cardiac surgery. J Thorac Cardiovasc Surg 2006;131:181-189.[Abstract/Free Full Text]
- Gaynor JW, Nicolson SC, Jarvik GP, Wernovsky G, Montenegro L, Burnham NB, et al. Increasing duration of deep hypothermic circulatory arrest is associated with an increased incidence of postoperative electroencephalographic seizures. J Thorac Cardiovasc Surg 2005;130:1278-1286.[Abstract/Free Full Text]
Related Article
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Electrographic seizure after neonatal and infant cardiac surgery
- Syed Faisal Hashmi, Muhammad Hanif, and Kathleen O'Reilly
J. Thorac. Cardiovasc. Surg. 2006 132: 441.
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