Brain Injury and Pediatric Cardiac Surgery

433 Pages·1995·84.419 MB·\433

by  Richard Jonas (Author), Jane Newburger (Author), Joseph Volpe (Author)

Brain Injury
and Pediatric
Cardiac Surgery

Brain Injury and
Pediatric Cardiac
Surgery
Richard A. Jonas, M.D.
William E. Ladd Professor of Surgery, Harvard Medical School;
Cardiovascular Surgeon in Chief, Department of Cardiac Surgery,
Children's Hospital, Boston
Jane W. Newburger, M.D., M.P.H.
Associate Professor of Pediatrics, Harvard Medical School; Senior Associate
in Cardiology, Department of Cardiology, Children's Hospital, Boston
Joseph J. Volpe, M.D.
Bronson Crothers Professor of Neurology, Harvard Medical School;
Neurologist-in-Chief, Department of Neurology, Children's Hospital,
Boston
Foreword by
John W. Kirklin, M.D.
Professor of Surgery, University of Alabama at Birmingham
Boca Raton London New York
CRC Press is an imprint of the
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First published 1996 by Butterworth-Heinemann
Published 2019 by CRC Press
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© 1996 by Taylor & Francis Group, LLC
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No claim to original U.S. Government works
ISBN 13: 978-0-7506-9567-l (hbk)
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Library of Congress Cataloging-in-Publication Data
Brain injury and pediatric cardiac surgery/ [edited by[ Richard A.
Jonas, Jane W. Newburger, Joseph J. Volpe; foreword by John W.
Kirklin.
p. em.
Includes bibliographical references and index.
ISBN 0-7506-9567-6 (alk. paper)
I. Congenital heart disease in children- Surgery-Complications.
2. Brain damage. 3. Infants- Surgery. I. Jonas, Richard A.
II. Newburger, Jane W. III. Volpe, Joseph J.
[DNLM: I. Brain Injuries- in infancy & childhood. 2. Brain-
-surgery. 3. Heart Surgery- in infancy & childhood. WS 340 B8138
1995[
RD598.B6928 1995
617.4'12'0083-dc20
DNLM/DLC
for Library of Congress 95-4025 7
CIP
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British
Library.
Contents
Contributing Authors ix
Foreword xiii
Preface xv
1. Brain Injury and Infant Cardiac Surgery: Overview 1
Joseph J. Volpe
Part I. Development of the Central Nervous System 11
2. Brain Development and Its Relationship to
Patterns of Injury 13
Michael V. Johnston
3. Maturation of Brain ATP Metabolism 29
David Holtzman and Miles Tsuji
4. EEG Maturation with Special Reference to
Epileptogenic Effects of Hypoxia 59
Frances E. Jensen
5. Programmed Cell Death: The Biology of Cell
Death in the Nematode Caenorhabditis elegans
and Implications for the Understanding and
Treatment of Human Brain Injury after Cardiac
Surgery 75
H. Robert Horvitz
Part II. Assessment of CNS Function 85
6. The Neurological Examination 87
Joseph J. Volpe
7. Cognitive and Psychomotor Developmental
Assessment 101
David Bellinger and Leonard A. Rappaport
8. EEG Methods with Particular Reference to
Neonatal Seizures 109
Gregory L. Holmes
v
vi Contents
9. Transcranial Doppler Technology: The Noninvasive
Monitoring of Cerebral Perfusion During
Cardiopulmonary Bypass 129
Frederick A Burrows
10. PET and SPECT in the Assessment of Cerebral
Function 143
Adre J. du Plessis and S. Ted Treves
11. Brain Monitoring Using Optical Imaging and
Optical Spectroscopy 153
David A. Benaron
12. Assessment of CNS Function: Cerebral Blood Flow
and Metabolism 185
William J. Greeley
13. Cerebral Evaluation with Nuclear Magnetic
Resonance Spectroscopy 192
Julie A. Swain
Part h i. Mechanisms of Neurological Injury 199
14. Mechanisms of Perinatal Ischemic Brain Damage 201
Robert C. Vannucci
15. Endothelial and White Cell Activation in Bypass
and Reperfusion Injury: Brain Injury 215
Paul R. Hickey
16. Excitotoxicity and Nitric Oxide 229
Stuart A. Lipton
Part IV. Clinical and Laboratory Studies of Cardiopulmonary
Bypass, Hypothermia, and Circulatory Arrest 239
17. A Newborn Canine Model of Hypothermic
Circulatory Arrest 241
Robert C. Vannucci
18. Effects of CPB, Hypothermia, and Circulatory
Arrest on Cerebral Blood Flow and Metabolism 255
William J. Greeley
19. Assessment by NMRS of the Effects of
Cardiopulmonary Bypass, Hypothermia, and
Circulatory Arrest 265
Julie A. Swain
20. pH Management During Hypothermic
Cardiopulmonary Bypass with Circulatory Arrest 271
Richard A. Jonas
Contents vii
Part V. A Prospective Clinical Study of Circulatory Arrest
at Children's Hospital, Boston 287
21. Methods and Procedures 289
fane W. Newburger and David Wypij
22. EEG Findings 311
Gregory L. Holmes, David Wypij, and
Sandra L. Helmers
23. Neurologic and MRI Findings 329
Karl C. K. Kuban and David Wypij
24. Developmental Findings at One Year 341
Leonard A. Rappaport, David Bellinger, and
David Wypij
25. Choreoathetosis 353
David L. Wessel and Adre J. du Plessis
Part VI. New Strategies for Cerebral Protection 363
26. New Strategies for Brain Protection Including
NMDA Receptor Antagonists 365
Michael V. Johnston
27. Cerebroplegia and Low Flow 375
Julie A. Swain
28. Pharmacological Modification of a Cerebroplegia
Solution 385
Richard A. Jonas and Mitsuru Aoki
Index 407

Contributing Authors
Mitsuru Aoki, M.D.
Assistant in Pediatric Cardiovascular Surgery, Tokyo Women's Medical Col-
lege; Associate in Pediatric Cardiovascular Surgery, Department of Pediatric
Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical
College, Tokyo
David Bellinger, Ph.D., M.Sc.
Associate Professor of Neurology, Harvard Medical School; Research Asso-
ciate, Department of Neurology, Children's Hospital, Boston
David A. Benaron, M.D.
Director, Biomedical Optics Group and Assistant Professor of Pediatric/
Neonatal Optics Group, Department of Pediatrics and Hansen Experimental
Physics Laboratory, Stanford University School of Medicine,* Attending
Neonatologist, Lucile Salter Packard Children's Hospital, Neonatal Inten-
sive Care, Palo Alto, CA
Frederick A. Burrows, M.D., FRCP(C)
Associate Professor of Anaesthesia, Harvard Medical School; Co-Director
of Cardiac Anesthesia Service, Department of Anesthesia, Children's Hos-
pital, Boston
Adre J. du Plessis, M.D., M.P.H.
Assistant Professor of Neurology, Harvard Medical School; Assistant in Neu-
rology, Department of Neurology, Children's Hospital, Boston
William J. Greeley, M.D.
Associate Professor of Anesthesiology and Pediatrics and Division Chief,
Division of Pediatric Cardiac Anesthesia and Critical Care Medicine, Duke
University Medical Center, Durham, NC
IX