The developmental and neurologic status of 155 children were evaluated one year after heart surgery for D-transposition of the great arteries, comparing those randomly assigned to circulatory arrest or low-flow cardiopulmonary bypass, at Children’s Hospital, Boston, MA. Circulatory arrest was associated with lower scores on the Bayley Scales of Infant Development, and the Psychomotor Development Index was inversely related to the duration of circulatory arrest. Risk of neurologic abnormalities also increased with the duration of circulatory arrest. A ventricular septal defect, present in 35 (23%), and seizure activity detected by continuous EEG monitoring in the early postoperative period were independent risk factors for a poor outcome. MRI abnormalities, and mental development and visual memory test scores were not correlated with the method of circulatory support. [1]

COMMENT. This report is a follow up of the perioperative neurologic effects of hypothermic circulatory arrest compared to low-flow cardiopulmonary bypass in 171 patients operated within the first three months of age at the Children’s Hospital, Boston [2]. Circulatory arrest was associated with a higher incidence of clinical and EEG seizures in the first 6 hours after surgery, but the incidence of neurologic abnormalities was similar in the two groups at time of discharge. (See Progress in Pediatric Neurology II, 1994, p386). It now appears that the technical advantages of total circulatory arrest may be outweighed by delayed motor development and neurologic abnormalities at one year and potential cognitive deficits at school age.

NEURODEVELOPMENTAL OUTCOME OF 11 INFANTS WITH SURGERY FOR HYPOPLASTIC LEFT HEART SYNDROME is reported from the State University of New York and Children’s Hospital of Buffalo [3]. Testing at a mean age of 38 months showed microcephaly in 8 (73%), mental retardation in 7 (64%), gross motor delays in 5 (45%), and severe cerebral palsy in 2 (18%). The quality of life is obviously seriously impaired in these patients, a factor to be considered in treatment options.