Pediatric cardiac surgery: Relevance to fetal and neonatal brain injury

Introduction In this chapter the impact of congenital heart disease and its surgical treatment on the neonatal brain will be discussed. Babies may have congenital cardiac disease as an isolated malformation or may have a heart defect as part of a larger spectrum of abnormalities, which may in turn be associated with a syndrome. In addition, these babies are often profoundly ill, presenting to medical attention on the verge of cardiac arrest with severe hypoxia, hypotension, or both. The treatment of the condition usually involves a trip to the catheterization laboratory or operating room (or both). We therefore have great potential for neurological morbidity, with a combination of possible underlying abnormality of the brain, preoperative, perioperative, and postoperative insults all conspiring to injure the cardiac surgery patient's brain. Despite these problems, the majority of babies do extremely well following heart surgery in the newborn period, although it is important to recognize that many of them will have a subtle neurological deficit if they are compared to the normal population. These are evidenced as cognitive and intellectual impairment, behavioral difficulties, speech delays, etc. The incidence of major neurological insult postoperatively as manifest by seizures, stroke, coma, or choreo-athetoid movements has fallen to around 2–11% in the current era.