An estimated 30,000 children are born in the USA with congenital heart disease each year, two thirds of which will require corrective surgery. Medical advances have formed a trend of operating on newborns rather than waiting until the child is older. Ten years ago, the mortality for these operationswas 60% to 70%. That percentage has dropped to 2%. This specialized book explores the basic mechanisms of neurologic injury associated with congenital heart surgery while covering the emerging technologies for assessment of neurologic integrity and injury. The text also highlights the current and future techniques for reducing and preventing these injuries, and reviews the pertinent medicolegal issues.
Table of Contents
PART I DEVELOPMENT OF THE CENTRAL NERVOUS SYSTEM: Brain Development and its Relationship to PAtterns of Injury Maturation of Brain ATP Metabolism EEG Maturation with Special Reference to Epiletogenic Effects of Hypoxia Programmed Cell Death The Biology of Cell Death in the Nematode Caenorhabditid elegans and Implications for the Understanding and Treatment of Human Brain Injury after Cardiac Surgery. PART II ASSESSMENT OF CNS FUNCTION: The Neurological Examination Cognitive and Psychomotor Developmental Assessment EEG Methods with PArticular Reference to Neonatal Seizures Transcranial Doppler Technology: The Noninvasive Monitoring of Cerebral Perfusion During Cardiopulmonary Bypass PET and SPECT in the Assessment of Cerebral Function Brain Monitoring Using Optical Imaging and Optical Spectroscopy Assessment of CNS Function: Cerebral Blood Flow and Metabolism Cerebral Evaluation with Nuclear Magnetic Resonance Spectroscopy. PART III MECHANISMS OF NEUROLOGICAL INJURY: Mechanisms of Perinatal Ischemic Brain Damage Endothelial and White Cell Activation in Bypass and Reperfusion Injury: Brain Injury Excitotoxicity and Nitric Oxide. PART IV CLINICAL AND LABORATORY STUDIES OF CARDIOPULMONARY BYPASS, HYPOTHERMIA AND CIRCULATORY ARREST: A Newborn Canine Model of Hypothermic Circulatory Arrest Effects on CPB, Hypothermia and Circulatory Arrests on Cerebral Blood Flow and Metabolism Assessment by NMRS of the Effects of Cardiopulmonary Bypass, Hypothermia and Circulatory Arrest pH MANAGEMENT During Hypothermic Cardiopulmonary Bypass with Circulatory Arrest. PART V A PROSPECTIVE CLINICAL STUDY OF CIRCULATORY ARREST AT CHILDREN'S HOSPITAL, BOSTON: Methods and Procedures EEG Findings Neurologic and MRI Findings
William E. Ladd Professor of Surgery, Harvard Medical School; Cardiovascular Surgeon in Chief, Department of Cardiac Surgery, Children's Hospital, Boston, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate in Cardiology, Department of Cardiology, Children's Hospital, Boston, Bronson Crothers Professor of Neurology, Harvard Medical School; Neurologist-in-Chief, Department of Neurology, Children's Hospital, Boston