Brain Computed Tomography Scan Findings in Children with Neurological Impairment During the Early Postoperative Period of Open-Heart Surgery for Congenital Heart Disease

 We evaluated the brain computed tomography (CT) scan findings of children with abnormal neurologic recovery during the postoperative period for corrective/palliative congenital heart surgery.

 This study was conducted at a referral educational pediatric hospital from May 2015 to May 2016. We included patients with congenital heart disease (CHD) who underwent corrective/palliative cardiac surgery presenting with abnormal neurologic recovery in the early postoperative period. We recorded the demographic data, past medical history, surgery details, type of neurological disorders leading to a brain CT scan, and postoperative coagulopathy.

 From among 734 cardiac surgeries from May 2015 to May 2016, 40 (5.44%) patients with abnormal neurologic recovery were assessed by brain CT scans. Among them, 55% were male and 45% were female with a mean age of 14.6 months. The most frequent heart anomaly was the transposition of great arteries (27.5%), which is known as the most common cause of cardiac surgery in the first month of life. Seizure (67.5%) was the most common neurologic manifestation and had the highest predictive value for the presence of an abnormal finding in the brain CT scan (91.3%). Intracranial hemorrhage, specifically subarachnoid hemorrhage, was the most frequent underlying pathology in brain CT scans of patients presenting with seizure. The most common findings in brain CT scans included subarachnoid hemorrhage (82.6%), intraparenchymal hemorrhage (26.08%), and ischemic infarction (17.39%). Data showed that a bypass time of over 180 min could significantly increase the probability of abnormal brain CT scan findings (P value = 0.03), particularly intra-parenchymal hemorrhage (P value = 0.016). The presence of coagulopathy concomitant with seizure would significantly increase the possibility of abnormal brain CT scan findings due to an acute neurologic event (P value = 0.049).

 This study showed seizure as the most common neurologic manifestation in the early postoperative period of cardiac surgery and the intracranial hemorrhage as the most common underlying pathology in patients with neurologic symptoms. Seizure in patients with coagulopathy should be considered as a great concern for physicians to evaluate acute neurologic events more precisely.