الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The incidence of congenital heart disease is 1 in 125 live births. It represent a significant problem in infant and child because of the perceived implications of its presence and because of hospital admissions and readmissions, diagnostic studies, invasive and non-invasive procedures and recurrent surgery. Children having congenital heart disease are at an increased risk for neurologic complications including stroke, cerebral abscesses, developmental delay, and mental retardation. These problems have been reported in as many as 25% of children with congenital heart disease.
Cyanotic congenital heart is known to be the most frequent predisposing factor of brain abscess in children.Tetralogy of Fallot is the most common cardiac anomaly associated with brain abscess due to being the commonest congenital heart disease with large right to left shunt.
Brain abscess should be suspected in all patients with congenital heart disease with septal defects presenting symptoms of central nervous system involvement. The advent of CT scans and their use in the management of these abscesses has resulted in a four fold decrease in the mortality rate in patients with brain abscesses secondary to cyanotic heart disease.
Neurological complications develop in 20% to 40% of patients with IE Intracranial MAs (ICMAs) represent a relatively small but extremely dangerous subset of these complications, The clinical presentation of patients with ICMAs is highly variable, endovascular treatment of ICMAs has been used as an alternative to surgical clipping or ligation. About one half of critical congenital heart disease infants will require surgical intervention in the first year of life. The incidence of neurological complications after pediatric cardiac surgery ranges from 2% to 25%. The etiology is multifactorial and include preoperative brain malformations, perioperative hypoxemia and low cardiac output states, sequelae of cardiopulmonary bypass, and deep hypothermic circulatory arrest.
Postponement of surgical repair in a child with cyanotic congenital heart disease is associated with progressive impairment of postoperative cognitive abilities.
Any strategy for prevention or rescue from adverse neurological events during CPB must start with the routine use of neurological monitoring systems that allow easy, reliable, and reproducible detection of these events.
The most important mechanism of stroke in cyanotic patients is via paradoxical embolism. A second alleged mechanism, hyperviscosity due to compensatory erythrocytosis
During childhood, the primary concerns are related to parental and sibling attachments, functioning at school, and phys¬ically keeping up with peers. During adolescence, the pri¬mary concerns are body image, sexuality, and struggle with separation from parents. Adult concerns include education, employment, insurability, marriage, and preg¬nancy.
There are four domains predictive of behavioral disorder in children with CHD: child health, child temperament, parent-child relationships, and family environment, the last of which is the most powerful predictor. Low economic status and large families increase the risk of depression. CHD can disrupt developmental achievements in school or work and give rise to concerns about premature mortality.