We thank Rosti and colleagues for their comments on our article reporting early neurological outcome after open heart surgery.1 They suggest that the series does not reflect the "normal spectrum" of congenital heart disease in infancy. To some extent, they are correct. However, the series does reflect the type of population that undergoes deep hypothermic cardiopulmonary bypass for repair of congenital heart defects, including severe left-sided lesions, in specialized centers in the United States. Of course, the results of studies performed over a relatively short period plus local referral practices and surgical attitudes will affect numbers when comparisons are made.
Rosti and colleagues also report a much lower incidence of postoperative neurological signs at their center. Their numbers were obtained from a retrospective records review, whereas ours were recorded in a rigorous, frequent, systematic prospective fashion, which included quantitative techniques, in an environment of heightened awareness.
We believe that
Miller G, Baylen BG. Early Neurologic Outcome After Open Heart Surgery on Young Infants-Reply. Arch Pediatr Adolesc Med. 1996;150(5):561. doi:10.1001/archpedi.1996.02170300114035