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Ann Thorac Surg 1990;50:714-719
© 1990 The Society of Thoracic Surgeons

Articles

Choreoathetosis after deep hypothermia without circulatory arrest

Serafin DeLeon, MD*,a,b,c, Michel Ilbawi, MDa,b,c, Rene Arcilla, MDa,b,c, Anthony Cutilletta, MDa,b,c, Robert Egel, MDa,b,c, Alfonso Wong, MDa,b,c, Jose Quinones, MDa,b,c, Tarek Husayni, MDa,b,c, Mounir Obeid, MDa,b,c, Rabi Sulayman, MDa,b,c, Farouk Idriss, MDa,b,c

a The Heart Institute for Children and Pediatric Neurology, Christ Hospital and Medical Center, Oak Lawn, USA
b Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, USA
c Department of Surgery, Northwestern University Medical School, Chicago, Illinois, USA

Accepted for publication June 7, 1990.

* Address reprint requests to Dr DeLeon, The Heart Institute for Children, Christ Hospital and Medical Center, 4440 W 95th St, Oak Lawn, IL 60453.

In 8 of 758 patients undergoing an intracardiac operation under cardiopulmonary bypass and hypothermia, choreoathetosis developed 3 to 7 days postoperatively. Before the onset of choreoathetosis, varying degrees of neurological dysfunction were noted. Electroencephalography and neuroimaging failed to detect any responsible functional or structural changes. Six patients are alive 1 to 3 years postoperatively, and their condition is improving. Two patients died of aspiration or sepsis. All patients were grouped based on factors identified as being possibly causative: depth of hypothermia, cooling time, flow rate, and repeated hypothermia. The incidence of choreoathetosis was significantly different in group A (rectal temperature > 25 °C compared with group B (rectal temperature ≤ 25 °C) ([equation] versus [equation]; p = 0.02). Based on cooling time, the incidence of choreoathetosis was significantly different in group B1 (cooling time < 1 hour) compared with group B2 (cooling time ≥ 1 hour) ([equation] versus [equation]; p = 0.05). Based on flow rate during cooling, group B2 was further divided into the low-flow group (< 1,500 mL · min–1 · m–2) and the high-flow group (≥ 1,500 mL · min–1 · m–2). Although not significant, the incidence of choreoathetosis was higher in the high-flow group ([equation]) versus [equation]; p = 0.22). In group B patients having reoperation, the incidence of choreoathetosis was higher than in patients operated on for the first time (5/54 versus [equation]; p <- 0.0001). Our data suggest that deep hypothermia of 25 °C or lower along with a cooling time of 1 hour or longer, maintenance of a high flow rate, and repeated exposure to hypothermia may predispose to the development of choreoathetosis postoperatively.




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