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January 1981, Vol 38, No. 1 >
Article | January 1981

Neuropsychologic Outcome After Open-Heart Surgery

Kyösti A. Sotaniemi, MD; Antero Juolasmaa, MA; Eero T. Hokkanen, MD
[+] Author Affiliations

Accepted for publication April 12, 1980.

Reprint requests to Department of Neurology, University of Oulu, 90220 Oulu 22, Finland (Dr Sotaniemi).


Arch Neurol. 1981;38(1):2-8. doi:10.1001/archneur.1981.00510010028003
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References
Comments

• A neuropsychologic (NP) study was carried out on 49 patients who had had cardiac valvular replacement to investigate the determinants of postoperative outcome. The results were assessed together with operative data and with neurologic and quantitative EEG (QEEG) findings. Of the operative variables, perfusion time and unexpected intraoperative events were the most important factors leading to postoperative NP impairment. Clinical neurologic outcome correlated positively with NP changes. Differences between various cardiologic and age groups were found in the postoperative NP findings. Changes in frequency in QEEG reflected the NP changes more reliably than did amplitude. Significantly one of the tests, a modification of the Stroop color test, was found to be prognostically important, suggesting that it might be possible to construct test batteries of value in predicting high operative risk. The results show that multiparameter investigation using NP testing together with clinical and QEEG follow-up is useful in the assessment of cerebral disorders attributable to open-heart surgery.

REFERENCES

1 +
Gilman S:  Cerebral disorders after open-heart surgery . N Engl J Med 272:489-498, 1965;.
2 +
Javid H, Tufo HM, Najafi H, et al:  Neurologic abnormalities following open-heart surgery . J Thorac Cardiorasc Surg 58:502-509, 1969;.
3 +
Tufo HM, Ostfeld AM, Shekelle R:  Central nervous system dysfunction following open-heart surgery . JAMA 212:1333-1340, 1970;.
4 +
Lorenz R, Hehrlein F:  Electroencephalographic findings in heart surgery . Arch Neurol 53:1069-1076, 1970;.
5 +
Hansotia PL, Myers WO, Ray JF, et al:  Prognostic value of electroencephalography in cardiac surgery . Ann Thorac Surg 19:127-134, 1975;.
6 +
Brierley JB:  Neuropathological findings in patients dying after open-heart surgery . Thorax 18:291-304, 1963;.
7 +
Aguilar MJ, Gerbode F, Hill J:  Neuropathologic complications of cardiac surgery . J Thorac Cardiovasc Surg 61:676-685, 1971;.
8 +
Wright G, Sanderson JM:  Brain damage and mortality in dogs following pulsatile and nonpulsatile blood flows in extracorporeal circulation . Thorax 27:738-747, 1971;.
9 +
Gurvitch AM, Ginsburg DA:  Types of hypoxic and posthypoxic delta activity in animals and man . Electroencephalogr Clin Neurophysiol 42:297-308, 1977;.
10 +
Blachly PH, Starr A:  Post-cardiotomy delirium . Am J Psychiatry 121:371-375, 1964;.
11 +
Kornfeld DS, Zimberg S, Malm JR:  Psychiatric complications of open-heart surgery . N Engl J Med 273:287-292, 1965;.
12 +
Lee WH, Brady MP, Rowe JM, et al:  Effects of extracorporeal circulation upon behaviour, personality and brain function . Ann Surg 173:1013-1023, 1971;.
13 +
Aberg T, Kihlgren M:  Effect of open-heart surgery on intellectual function . Scand J Thorac Cardiovasc Surg , (suppl 15) , 1974;.
14 +
Hill JD, Osborn JJ, Swank RL, et al:  Experience using a new Dacron wool filter during extracorporeal circulation . Arch Surg 101:649-652, 1970;.
15 +
Branthwaite MA:  Neurological damage related to open-heart surgery . Thorax 27:748-753, 1972;.
16 +
Åberg T, Kihlgren M:  Cerebral protection during open-heart surgery . Thorax 32:525-533, 1977;.
17 +
Ross Russell RW, Bharucha N:  The recognition and prevention of border zone ischaemia during cardiac surgery . Q J Med 47:303-323, 1978;.
18 +
Speidel H, Dahme B, Flemming B, et al:  Psychische Störungen nach offenen Herz-operationen . Nervenarzt 50:85-91, 1979;.
19 +
Sotaniemi KA:  Brain damage and neurological outcome after open-heart surgery . J Neurol Neurosurg Psychiatry 43:127-135, 1980;.
20 +
Rabiner CJ, Willner AE, Fishman J:  Psychiatric complications following coronary bypass surgery . J Nerv Ment Dis 160:343-348, 1975;.
21 +
Rabiner CJ, Willner AE:  Psychopathology observed on follow-up after coronary bypass surgery . J Nerv Ment Dis 163:295-301, 1976;.
22 +
Jaedicke-Hollender K, Jaedicke W, Steinkrauss G, et al:  Psychiatrisch-neurologische Befunde vor und nach aortocoronarer Bypass-Operationen . Nervenarzt 50:92-101, 1979;.
23 +
Mohr JP:  Neurological complications of cardiac valvular disease and cardiac surgery including systemic hypotension , in Vinken PJ, Bruyn GE (eds): Handbook of Clinical Neurology . New York, Elsevier North Holland Inc, 1979;, vol 38, pt 1, pp 143-167.
24 +
Dumermuth G, Flühler H:  Some modern aspects in numerical spectrum analysis of multichannel electroencephalographic data . Med Biol Eng 5:319-331, 1967;.
25 +
Hjorth B:  EEG analysis based on time domain properties . Electroencephalogr Clin Neurophysiol 29:306-310, 1970;.
26 +
Hjorth B:  The physical significance of time domain descriptors in EEG analysis . Electroencephalogr Clin Neurophysiol 34:321-325, 1973;.
27 +
Sotaniemi KA, Sulg IA, Hokkanen TE:  Quantitative EEG as a measure of cerebral dysfunction before and after open-heart surgery . Electroencephalogr Clin Neurophysiol , to be Published.
28 +
Stroop JR:  Studies of interference in serial verbal reactions . J Exp Psychol 18:643-662, 1935;.
29 +
Weckroth J, Tienari P, Airikkala K:  A comparison of the ability structure of two groups of brain injured patients with different locations on the left-right hemisphere dimension  in Reports From the Institute of Occupational Health , No. 25. Helsinki, Institute of Occupational Health, 1975;.
30 +
Airikkala K: Weckroth's Test Battery for Identification of Brain Damage . Helsinki, Institute of Occupational Health, 1966;.
31 +
Golden CJ:  Identification of brain disorders by the Stroop color and word test . J Clin Psychol 32:654-658, 1976;.
32 +
Lezak MD: Neuropsychological Assessment . New York, Oxford University Press, 1976;.
33 +
Porteus SD: Porteus Maze Test . Palo Alto, Calif, Pacific Books, 1973;.
34 +
Tow PM: Personality Changes Following Frontal Leucotomy . London, Oxford University Press, 1955;.
35 +
Smith A, Kinder EF:  Changes in psychological test performances of brain operated schizophrenics after eight years . Science 129:149-150, 1959;.
36 +
Goldstein K, Scheerer M:  Abstract and concrete behaviour: An experimental study with special tests . Psychol Monogr 53:1-151, 1941;.
37 +
Benton AL:  Constructional apraxia: Some unanswered questions , in Benton AL (ed): Contributions to Clinical Neuropsychology . New York, Aldine, 1969;.
38 +
Von Fieandt K, Kalimo E: Wechsler Adult Intelligence Scale: A Manual . Helsinki, Psykologien Kustannus, 1975;.
39 +
Branthwaite MA:  Prevention of neurological damage during open-heart surgery . Thorax 30:258-261, 1975;.
40 +
Gilberstadt H, Sako Y:  Intellectual and personality changes following open-heart surgery . Arch Gen Psychiatry 16:210-214, 1967;.
41 +
Frank KA, Heller SS, Kornfeld DS, et al:  Long-term effects of open-heart surgery on intellectual functioning . J Thorac Cardiovasc Surg 64:811-815, 1972;.
42 +
Willner AE, Rabiner CJ, Wisoff BG, et al:  Analogy tests and psychopathology at follow-up after open-heart surgery . Biol Psychiatry 11:678-696, 1976;.
43 +
Gruvstad M, Kebbon L, Löf B:  Changes in mental functions after induced hypotension . Acta Psychiatr Scand 37( (suppl 163) ), 1962;.
44 +
Hazan SJ:  Psychiatric complications following cardiac surgery: I. Review article . J Thorac Cardiovasc Surg 51:307-310, 1966;.
45 +
Kilpatrick DG, Miller WC, Allan AN, et al:  The use of psychological test data to predict open-heart surgery outcome: A prospective study . Psychosom Med 37:62-73, 1975;.
46 +
Burggraf GW, Craige E:  Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery . Am J Cardiol 35:473-478, 1975;.
47 +
Karp HR:  Cerebral vascular disease and neurologic manifestations of cardiovascular disease , in Hurst JW (ed): The Heart , ed 4. New York, McGraw-Hill Book Co, 1978;, p 1890.
48 +
Sulg IA, Hokkanen TE, Saarela E, et al: Computerized quantitative EEG and blood pressure monitoring during high risk surgery, in Eleventh World Congress of Neurology, Amsterdam 1977, Book of Abstracts. International Congress series 427. Amsterdam, Excerpta Medica, 1977, abstract 522.

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1 +
Gilman S:  Cerebral disorders after open-heart surgery . N Engl J Med 272:489-498, 1965;.
2 +
Javid H, Tufo HM, Najafi H, et al:  Neurologic abnormalities following open-heart surgery . J Thorac Cardiorasc Surg 58:502-509, 1969;.
3 +
Tufo HM, Ostfeld AM, Shekelle R:  Central nervous system dysfunction following open-heart surgery . JAMA 212:1333-1340, 1970;.
4 +
Lorenz R, Hehrlein F:  Electroencephalographic findings in heart surgery . Arch Neurol 53:1069-1076, 1970;.
5 +
Hansotia PL, Myers WO, Ray JF, et al:  Prognostic value of electroencephalography in cardiac surgery . Ann Thorac Surg 19:127-134, 1975;.
6 +
Brierley JB:  Neuropathological findings in patients dying after open-heart surgery . Thorax 18:291-304, 1963;.
7 +
Aguilar MJ, Gerbode F, Hill J:  Neuropathologic complications of cardiac surgery . J Thorac Cardiovasc Surg 61:676-685, 1971;.
8 +
Wright G, Sanderson JM:  Brain damage and mortality in dogs following pulsatile and nonpulsatile blood flows in extracorporeal circulation . Thorax 27:738-747, 1971;.
9 +
Gurvitch AM, Ginsburg DA:  Types of hypoxic and posthypoxic delta activity in animals and man . Electroencephalogr Clin Neurophysiol 42:297-308, 1977;.
10 +
Blachly PH, Starr A:  Post-cardiotomy delirium . Am J Psychiatry 121:371-375, 1964;.
11 +
Kornfeld DS, Zimberg S, Malm JR:  Psychiatric complications of open-heart surgery . N Engl J Med 273:287-292, 1965;.
12 +
Lee WH, Brady MP, Rowe JM, et al:  Effects of extracorporeal circulation upon behaviour, personality and brain function . Ann Surg 173:1013-1023, 1971;.
13 +
Aberg T, Kihlgren M:  Effect of open-heart surgery on intellectual function . Scand J Thorac Cardiovasc Surg , (suppl 15) , 1974;.
14 +
Hill JD, Osborn JJ, Swank RL, et al:  Experience using a new Dacron wool filter during extracorporeal circulation . Arch Surg 101:649-652, 1970;.
15 +
Branthwaite MA:  Neurological damage related to open-heart surgery . Thorax 27:748-753, 1972;.
16 +
Åberg T, Kihlgren M:  Cerebral protection during open-heart surgery . Thorax 32:525-533, 1977;.
17 +
Ross Russell RW, Bharucha N:  The recognition and prevention of border zone ischaemia during cardiac surgery . Q J Med 47:303-323, 1978;.
18 +
Speidel H, Dahme B, Flemming B, et al:  Psychische Störungen nach offenen Herz-operationen . Nervenarzt 50:85-91, 1979;.
19 +
Sotaniemi KA:  Brain damage and neurological outcome after open-heart surgery . J Neurol Neurosurg Psychiatry 43:127-135, 1980;.
20 +
Rabiner CJ, Willner AE, Fishman J:  Psychiatric complications following coronary bypass surgery . J Nerv Ment Dis 160:343-348, 1975;.
21 +
Rabiner CJ, Willner AE:  Psychopathology observed on follow-up after coronary bypass surgery . J Nerv Ment Dis 163:295-301, 1976;.
22 +
Jaedicke-Hollender K, Jaedicke W, Steinkrauss G, et al:  Psychiatrisch-neurologische Befunde vor und nach aortocoronarer Bypass-Operationen . Nervenarzt 50:92-101, 1979;.
23 +
Mohr JP:  Neurological complications of cardiac valvular disease and cardiac surgery including systemic hypotension , in Vinken PJ, Bruyn GE (eds): Handbook of Clinical Neurology . New York, Elsevier North Holland Inc, 1979;, vol 38, pt 1, pp 143-167.
24 +
Dumermuth G, Flühler H:  Some modern aspects in numerical spectrum analysis of multichannel electroencephalographic data . Med Biol Eng 5:319-331, 1967;.
25 +
Hjorth B:  EEG analysis based on time domain properties . Electroencephalogr Clin Neurophysiol 29:306-310, 1970;.
26 +
Hjorth B:  The physical significance of time domain descriptors in EEG analysis . Electroencephalogr Clin Neurophysiol 34:321-325, 1973;.
27 +
Sotaniemi KA, Sulg IA, Hokkanen TE:  Quantitative EEG as a measure of cerebral dysfunction before and after open-heart surgery . Electroencephalogr Clin Neurophysiol , to be Published.
28 +
Stroop JR:  Studies of interference in serial verbal reactions . J Exp Psychol 18:643-662, 1935;.
29 +
Weckroth J, Tienari P, Airikkala K:  A comparison of the ability structure of two groups of brain injured patients with different locations on the left-right hemisphere dimension  in Reports From the Institute of Occupational Health , No. 25. Helsinki, Institute of Occupational Health, 1975;.
30 +
Airikkala K: Weckroth's Test Battery for Identification of Brain Damage . Helsinki, Institute of Occupational Health, 1966;.
31 +
Golden CJ:  Identification of brain disorders by the Stroop color and word test . J Clin Psychol 32:654-658, 1976;.
32 +
Lezak MD: Neuropsychological Assessment . New York, Oxford University Press, 1976;.
33 +
Porteus SD: Porteus Maze Test . Palo Alto, Calif, Pacific Books, 1973;.
34 +
Tow PM: Personality Changes Following Frontal Leucotomy . London, Oxford University Press, 1955;.
35 +
Smith A, Kinder EF:  Changes in psychological test performances of brain operated schizophrenics after eight years . Science 129:149-150, 1959;.
36 +
Goldstein K, Scheerer M:  Abstract and concrete behaviour: An experimental study with special tests . Psychol Monogr 53:1-151, 1941;.
37 +
Benton AL:  Constructional apraxia: Some unanswered questions , in Benton AL (ed): Contributions to Clinical Neuropsychology . New York, Aldine, 1969;.
38 +
Von Fieandt K, Kalimo E: Wechsler Adult Intelligence Scale: A Manual . Helsinki, Psykologien Kustannus, 1975;.
39 +
Branthwaite MA:  Prevention of neurological damage during open-heart surgery . Thorax 30:258-261, 1975;.
40 +
Gilberstadt H, Sako Y:  Intellectual and personality changes following open-heart surgery . Arch Gen Psychiatry 16:210-214, 1967;.
41 +
Frank KA, Heller SS, Kornfeld DS, et al:  Long-term effects of open-heart surgery on intellectual functioning . J Thorac Cardiovasc Surg 64:811-815, 1972;.
42 +
Willner AE, Rabiner CJ, Wisoff BG, et al:  Analogy tests and psychopathology at follow-up after open-heart surgery . Biol Psychiatry 11:678-696, 1976;.
43 +
Gruvstad M, Kebbon L, Löf B:  Changes in mental functions after induced hypotension . Acta Psychiatr Scand 37( (suppl 163) ), 1962;.
44 +
Hazan SJ:  Psychiatric complications following cardiac surgery: I. Review article . J Thorac Cardiovasc Surg 51:307-310, 1966;.
45 +
Kilpatrick DG, Miller WC, Allan AN, et al:  The use of psychological test data to predict open-heart surgery outcome: A prospective study . Psychosom Med 37:62-73, 1975;.
46 +
Burggraf GW, Craige E:  Echocardiographic studies of left ventricular wall motion and dimensions after valvular heart surgery . Am J Cardiol 35:473-478, 1975;.
47 +
Karp HR:  Cerebral vascular disease and neurologic manifestations of cardiovascular disease , in Hurst JW (ed): The Heart , ed 4. New York, McGraw-Hill Book Co, 1978;, p 1890.
48 +
Sulg IA, Hokkanen TE, Saarela E, et al: Computerized quantitative EEG and blood pressure monitoring during high risk surgery, in Eleventh World Congress of Neurology, Amsterdam 1977, Book of Abstracts. International Congress series 427. Amsterdam, Excerpta Medica, 1977, abstract 522.

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