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J Pediatr Intensive Care 2012; 01(01): 037-041
DOI: 10.3233/PIC-2012-007
Georg Thieme Verlag KG Stuttgart – New York

The role of EEG recordings in children undergoing cardiac surgery for congenital heart disease

Sascha Meyer   1
a   University Hospital of Saarland, Department of Pediatrics and Neonatology, Neuropediatrics, Homburg/Saar, Germany
,
Mohammed Ghiath Shamdeen   1
a   University Hospital of Saarland, Department of Pediatrics and Neonatology, Neuropediatrics, Homburg/Saar, Germany
,
Mohammed Shatat
b   Department of Pediatric Cardiology, University Hospital of Saarland, Germany
,
Hans-Jochaim Schäfers
c   Department of Cardiothoracic Surgery, University Hospital of Saarland, Germany
,
Ludwig Gortner
a   University Hospital of Saarland, Department of Pediatrics and Neonatology, Neuropediatrics, Homburg/Saar, Germany
,
Sven Gottschling
d   Department of Pediatrics, University Hospital of Saarland, Germany
,
Hashim Abdul-Khaliq
b   Department of Pediatric Cardiology, University Hospital of Saarland, Germany
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Publication History

Publication Date:
28 July 2015 (online)

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Abstract

Neurological dysfunction may occur after corrective cardiac surgery using cardio-pulmonary bypass (CPB) with or without circulatory arrest. Different neurophysiological monitoring systems have been employed to detect neurological complications and possible brain injury in infants and children during and after cardiac surgery. The value of EEG in infants and children at risk for neurological sequelae has not been systematically studied.

Sequential performance of 2 EEGs before and after cardiac surgery at a tertiary University Hospital to screen for possible brain injury after cardiac surgery. In addition, a complete neurological examination was performed.

In 313 patients (age: 54.2±55.7 months; normal initial EEG) after cardiac surgery CPB (duration of surgery: 146.0±58.9 minutes; aortic cross clamp time: 34.1±19.1 minutes) a 19-channel EEG recording was performed 2.4±1.8 days prior and 11.6±5.3 days after cardiac surgery. An abnormal EEG was detected in only 8 of 313 patients (2.5%; focal slowing(1), generalised slowing (5), epiletiform discharges(2)) after cardiac surgery, while the EEG was normal in the remaining 305 patients (97.5%). In one patient, an intra-cerebral pathology was seen on MRI (ischemic); in 5 patients follow-up EEGs were performed, which revealed normalised findings. None of the 8 patients demonstrated new focal neurological deficits on physical examination, but 33 (9.7%) children demonstrated minor abnormalities (eg, subtle motor asymmetry, increase in muscle tone, etc.), which were unrelated to abnormal EEG findings.

According to the used protocol pathological EEG findings were very infrequent in our study cohort. The routine and indiscriminative recording of EEGs in children before and after corrective or palliative cardiac surgery for congenital heart disease using CPB is not recommended. Further intra-operative neuromonitoring methods with immediate intervention should be evaluated.

Keywords

Congenital heart disease - cardiac surgery - cardiopulmonary bypass - electroencephalography - children - neurological sequelae

1 SM and MGS contributed equally to this work