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Three distinct subgroups of patients who had undergone HT were identified: six infants with uncorrected hypoplastic left heart syndrome(HLHS),three infants with HLHS who had undergone previous stage 1 Norwood repair,and eight older children with end-stage cardiomyopathy.Fourteen(82%)of 17 children were alive at follow-up.Only one patient(7%)had a significant acquired neurologic deficit(left temporal lobe stroke with subsequent seizures in an infant with uncorrected HLHS).The remaining subjects had normal results of post-HT neurologic examinations(n=7),minor post-HT neurologic abnormalities(n=3),no significant change in preexisting neurologic abnormalities(n=1),or normal neurologic status by report(n=2). The minor neurologic abnormalities noted post-HT were dysmetria,tremor and absent reflexes.No episodes of choreoathetosis or cyclosporine-related seizures were seen.Pediatric HT is associated with both a high survival rate and a low incidence of severe acquired neurologic deficits despite a significant incidence of severe systemic and metabolic derangements in the pretransplantation and posttransplantation periods.In infants with HLHS,HT seems to carry a lower incidence of severe neurologic morbidity(12%)than other surgical treatments. |
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