Autopsy Study on the Causes of Coma in Cases with Congenital Heart Disease Following Cardiac Surgery after Extracorporeal Circulation / 中国胸心血管外科临床杂志

ABSTRACT

Objective　To observe the morphological changes of brain and to analyze the cause of coma after open-heart surgery in cases suffered from congenital heart disease.　Methods　Twenty six autopsy cases were collected from Jan. 1973 to Sep. 1999 in Fuwai Hospital. Their duration of coma was 1 day to 40 days and all of them died earlier later following cardiac surgery. Their surgical procedure, extracorporeal circulation time, and other clinical records and autopsy findings were reviewed. 　Results　The brain lesions included intracranial hemorrhages (n＝11), cerebral edema (n＝11), encephalitis and encephalomingitis (n＝3), and cerebromalacia (n＝1). Intracranial hemorrhages occurred in epidural (n＝3), subdural (n＝3), subarachoid spaces (n＝4), and intracerebral parenchyma (n＝1). The causes of coma were deduced as follows lower cardiac output (n＝7), air embolism (n＝3), pneumonia (n＝3) and other infections (n＝2), pulmonary hypertension (n＝2), and the unknown causes of coma (n＝9). But the 6 out of the last 9 cases showed longer duration (more than 100 min) of extracorporeal circulation. Intracranial hemorrhages occurred more frequently in cases with waking period than those without after cardiac operation, and vice versa the cerebral edema. 　Conclusion　Intracranial hemorrhage and cerebral edema were the main changes of brain in the patients suffered from coma, but its causes were complex and difficult to analyze. These results suggest that further improved heart preservation, shorter time of extracorporeal circulation and effective treatment of infection would be benefit to the prevention of coma.