Abnormal movements following heart surgery: A series of pediatric post-pump chorea

Abstract

Introduction

Neurological disorders following heart surgery are mainly attributable to strokes. However there is a rare cause of abnormal movement following heart surgery: post-pump chorea. This complication is rare and poorly described particularly with regard to its therapeutic management and evolution.

Methods

Descriptive monocentric retrospective study including all children with post-pump chorea over a 10-year period (2014–2023). Clinical presentation, radiological findings, and outcomes were analyzed based on clinical, biological, and cerebral imaging data.

Results

Over 10 years, 7059 pediatric cardiac surgeries with cardiopulmonary bypass (CBP) were performed at Necker hospital, and 11 patients experienced post-pump chorea (0.15%), including 5 boys (45%). Median age at the diagnosis of post-pump chorea was 5.7 years [0.45–9.9]. One patient was premature, and none had genetic syndromes. Median BMI was low (14.8 [11.9–17.4]). Six patients had cyanotic heart disease. Six patients (55%) had previously undergone surgery with CBP. Median CBP duration and length of stay in the intensive care unit were typical, at 132 minutes [64–362] and 6 days [1–186], respectively. The interval between surgery and symptom onset was 20 days [4–64], with a median duration of 44 days [3–181]. Abnormal movements primarily affected the face (100%) and were often bilateral (82%), involving the upper limbs (91%) and lower limbs (82%). Initial cerebral MRI did not show recent ischemic lesions. Six patients (55%) received medical treatment: tetrabenazine (n = 2), intravenous immunoglobulins (n = 1), corticosteroids (n = 1), L-Dopa (n = 1), cyamemazine (n = 1). Chorea persisted beyond 6 months in only 1 out of 11 patients.

Conclusion

Post-pump chorea is extremely rare and can occur several months after cardiac surgery. It does not appear to be directly related to perioperative severity criteria. The prognosis is generally favorable within 6 months following diagnosis.