Neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases at a Tertiary Care Cardiac Setup of Pakistan: A single center study.

Abstract

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p<0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p<0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery.