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Diagnosis and Treatment of ADD, Learning Disabilities, Migraines, and Traumatic Brain Injury

Neuropsychological Effects of Cardiac Surgery

Cognitive and fatigue problems after heart surgery (sometimes called cardiac bypass surgery).

The patient who has had cardiac bypass surgery is usually not warned about possible cognitive problems after the surgery, and thus the person can sink into a depression because they do not understand why they cannot function the way they used to.  Sometimes there is tremendous fatigue, especially in the late afternoon (this can also happen with a mild head injury). Sometimes apparent memory problems are experienced, far out of proportion to their memory problems before the surgery.

Since there are thousands of  such surgeries every year, there must be many, many cases which are similar to those described above.  Even if there has been some resulting brain damage as a result of the surgery, there is some hope:  There is a new treatment called neurofeedback which might be able to help “tune up the brain” to some extent.  Information about this can be found by downloading the EEG Biofeedback manual here.

The following bibliography provides references about the cognitive problems which occur after cardiac by-pass surgery.  It was compiled in 2006 to convince an insurance company that the patient in question was not suffering from chronic fatigue syndrome, but had suffered a brain injury from his cardiac bypass operation the previous year.  We won the case after doing a detailed neuropsychological evaluation.

Additions to this list would be appreciated, and can be sent to nurosvcs@aol.com.

Aberg, T., & Kihlgren, M. (1974). Effect of open heart surgery on intellectual function. Scandinavian Journal of Thoracic and Cardiovascular Surgery 15 (Supplement): 15.

Aberg, T., & Kihlgren, M. (1977). Cerebral protection during open-heart surgery. Thorax 32: 525-533.

Aberg, T., & Ronquist, G., Tyden, H., Ahlund, P., & Bergstrom, K. (1982). Release of adenylate kinase into cerebrospinal fluid during open-heart surgery and its relation to post-operative intellectual function. Lancet 2 (1139-1142).

Aberg, T., Ronquist, G., Tyden, H., Brunnkvist, S., Hultman, J., Bergstrom, K., & Lilja, A. (1984). Adverse effects on the brain in cardiac operations as assessed by biochemical, psychometric, and radiologic methods. Cardiovascular Surgery 87 (99-105).

Aberg, T., Ronquist, G., Tyden, H., Brunnkvist, S., & Bergstorm, K. (1987). Cerebral damage during open-heart surgery. Scandinavian Journal of Thoracic and Cardiovascular Surgery 21 (159-163).

Ahlgren, E., & Aren, C. (1998). Cerebral complications after coronary artery bypass and heart valve surgery: risk factors and onset of symptoms. Journal of Cardiothoriac and Vascular Anesthesia 12 (Jun): 3270-3273.

Aris, A., Solanes, H., Camara, M. L., Junque, C., Escartin, A., & Caralps, J. M (1986). Arterial line filtration during cardiopulmonary bypass: Neurologic, neuropsychologic, and hematologic studies. Journal of Thoracic and Cardiovascular Surgery 91: 526-533.

Arrowsmith, J. E., Harrison, D.M., Newman, S.P., Stygall, J., Timberlake, N., & Pugsley, W.B. (1998). Neuroprotection of the brain during cardiopulmonary bypass. Stroke 29 (11): 2357-2362.

Barnett, H. J. M. (1983). Heart in ischemic stroke – a changing emphasis. in Neurologic Clinics. Symposium on Cerebrovascular disease. H. J. M. E. In: Barnett. Philadelphia: WB Saunders: 291-315.

Becker, R. K., J., Polonius, Speodel, Ed. (1982). Psychopathological and neurological dysfunctions following open heart surgery. Berlin: Springer-Verlag.

Benedict, R. B. (1994). Cognitive function after open-heart surgery: Are postoperative neuropsychological deficits caused by cardiopulmonary bypass? Neuropsychology Review 4: 223-255.

Blachy, P. H., Blachly, P. J. (1968). Vocational and emotional status of 263 patients after open-heart surgery. Circulation 38: 524-532.

Blumental, J. A., Madden, D. J., Burker, E. J., Croughwell, C. R. N., Schniebolk, S., Smith, R., White, W. D., Hlatky, M., & Reves, J. G. (1991). A preliminary study of the effects of cardiac procedures on cognitive performances. International Journal of Psychosomatics 38: 13-16.

Bojar, R. M., Furian, A.J., Hanson, M.R., et al (1983). Neurological complications of coronary revascularization. Ann Thorac Surg 36: 427-432.

Boll, A., Dahme, B., Meffert, H. J., & Speidel, H. (1990). Psychological adaptation of patients 3 to 5 years after heart surgery. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 61-72.

Bornstein, R. A., & Kelly, M. P. (1991). Risk factors for stroke and neuropsychological performance. in Neurobehavioral Aspects of Cerebrovascular Disease. New York: Oxford University Press.

Borowicz, L. M., Goldsborough, M. A., Selenes, O. A., and McKhann, G. M. (1996). Neuropsychologic change after cardiac surgery: a critical review. Journal of Cardiothoriac and Vascular Anesthesia 10 (Jan): 1105-1111.

Branthwaite, M. A. (1972). Neurological damage related to open-heart surgery. Thorax 27: 748-753.

Branthwaite, M. A. (1975). Prevention of neurological damage during open-heart surgery. Thorax 30: 258-261.

Braunwald, E. (1983). Editorial retrospective: Effects of coronary artery bypass grafting on survival. New England School of Medicine 369: 1181-1184.

Breuer, A. C., Furlan, A. J., Hanson, M. R., et al. (1983). Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients. Stroke 14: 682-687.

Brierley, J. B. (1967). Brain damage complicating open-heart surgery: A neuropathological study of 46 patients. Proceedings of the Royal Society of Medicine 60 (34-35).

Bruggemans. E. F., F., J.R. V., & Huysmans, H. A., (1997). Assessment of cognitive deterioration in individual patients following cardiac surgery:  Correcting for measurement error and practice effects. J. Clinical and Experimental Neuropsychology 19 (4): 543-559.

Bruggemans. E. F., V. D., J. G., & Huysmans, H. A., (1995). Residual cognitive dysfunctioning at 6 months following coronary artery bypass graft surgery. Euro J Cardiothorac Surg 9 (636-643).

Chelune, G. J. (1992). Using neuropsychological data to forecast postsurgical cognitive outcome. in Epilepsy surgery. H. O. E. In: Luders. New York: Raven Press: 477-485.

Dahme, B., & Pokar, H. (1990). Anesthesia and psychometric tests – problems in psychological assessment of cognitive recovery after anesthesia. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 319-326.

De Silva, R. A., Bachman, W. R., (1995). Cardiac consultation in patients with neuropsychiatric problems. Cardiol Clin 13 (2) (May): 225-239.

Ehrenhaft, J. L., & Claman, M. A, (1961). Cerebral complications of open-heart surgery. Journal of Thoracic and Cardiovascular Surgery 42: 514-526.

Ellis, R. J. (1982). Pathophysiology and Techniques of Cardiopulmonary Bypass. Baltimore, MD: Williams & Witkins.

Elsass, P., & Henriksen, L. (1984). Acute cerebral dysfunction after open-heart surgery: A reaction-time study. Scandinavian Journal of Thoracic and Cardiovascular Surgery 18: 161-165.

Emskoetter, T., & Lachenmayer, L. (1990). The susceptibility of the central nervous system to open heart surgery. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 97-104.

Feys-Dunne, N., & Willner, A. E. (1990). Changes in psychometric test scores after cardiac surgery. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 167-172.

Fish, K. J., Helms, K., Sarnquist, F. H., Tinklenberg, J & Miller, D. C., (1982). Neuropsychological dysfunction after coronary artery surgery. Anesthesiology 57: A55.

Fish, K. J., Helms, K. N., Sarnquist, F. H., Steennis, C., Linet, O. I., Hilberman, M., Mitchell, R. S., Jamieson, S. W., Miller, D. C., and Tinklenberg, J. S. (1987). A prospective, randomized study of the effects of prostacyclin on neuropsychologic dysfunction after coronary artery operation. Journal of Thoracic and Cardiovascular Surgery 93: 609-615.

Folks, D. G., Franceschini, J., Sokol, R. S., Freeman, A. M., & Folks, D. M. (1986). Coronary artery bypass surgery in older patients: Psychiatric morbidity. Southern Medical Journal 79: 303-306.

Frank, K. A., Heller, S. S., Kornfeld, D. S., & Malm, J. R (1972). Long-term effects of open-heart surgery on intellectual functioning. Journal of Thoracic and Cardiovascular Surgery 64: 811-815.

Frater, R. W. M. (1982). Neuropsychological dysfunction following elective cardiac operation II. A six-month re-assessment. Journal of Thoracic and Cardiovascular Surgery 84: 595-600.

Freeman, A. M., Folks, D. G., Sokol, R. S., et al. (1985). Cognitive function after coronary bypass surgery: Effect of decreased cerebral blood flow. American Journal of Psychiatry 142: 110-112.

Fuse, K., Makuuchi, H. (1988). Early and late results of coronary artery bypass grafting in the elderly. Jpn Circ J 52: 460-465.

Garvey, J. W., Willner, A., Wolpowitz, A., Caramante, L., Rabiner, C. J., Weisz, D., & Wisoff, B. G. (1983). The effect of arterial filtration during open-heart surgery on cerebral function. Circulation 68 (Supplement II): 125-128.

Gilberstadt, H., and Sako, Y. (1967). Intellectual and personality changes following open-heart surgery. Archives of General Psychiatry 16: 210-214.

Gilman, S. (1965). Cerebral disorders after open-heart surgery. New England Journal of Medicine 272 (489-498).

Govier, A. V. (1989). Cardiopulmonary Bypass: Current Concepts and Controversies. Philadelphia, PA: W. B. Saunders Co.,.

Grieco, G., D'Hollosy, M., Culliford, A. T., Jonas, S., (1996). Evaluating neuroprotective agents for clinical anti-ischemic benefit using neurological and neuropsychological changes after cardiac surgery under cardiopulmonary bypass. Stroke 27: 858-874.

Griffin, S., Klinger, L., Newman, S., Hothersall, J., McLean, P., Harrison, M., Sturridge, M., Treasure, T. (1992). The effect of substrate load and blood glucose management on cerebral dysfunction following cardiopulmonary bypass. Vasc Surg. 26: 656-664.

Grote, C. L., Shanahan, P. T., Salmon, P., Myers, R. G., Barrett, C., & Lansing, A. (1992). Cognitive outcome after cardiac operations: Relationship to intraoperative computerized electroencephalographic data. Journal of Thoracic and Cardiovascular Surgery 104: 1405-1409.

Gur, R. (1993). Neuropsychological methods for evaluating regional brain dysfunction. in Cerebral damage before and after cardiac surgery. A. E. Willner. Dordrecht, The Netherlands: Kluwer Academic Publishers: 101-112.

Hammeke, T. A., & Hastings, J. E., (1988). Neuropsychologic alterations after cardiac operation. Journal of Thoracic and Cardiovascular Surgery 96: 326-331.

Harrison, M. J. G., Schneidau, A., Ho, R., Smith, P. L. C., Newman, S., & Treasure, T. (1989). Cerebrovascular disease and functional outcome after coronary artery bypass surgery. Stroke 20: 235-237.

Harter, G. W., Williams, J. M., George, W. E., Mutchnick, M., & Torres, I. (1990). Memory functioning after cardiac surgery with cardiopulmonary bypass: comparisons between heart and back patients. in Impact of cardiac surgery on the quality of life: neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 201-210.

Heller, S. S., Frank, K. A., Malm, J. R., (1970). Psychiatric complications of open-heart surgery: a re-examination. New England Journal of Medicine 28: 1015-1020.

Heller, S. S., Frank, K. A., Kornfled, D. S, et al (1974). Psychological outcome following open-heart surgery. Archives of Intern Med 134: 908-914.

Henriksen, L., Hjelms, E., & Lindeburg, T. (1983). Brain hypoperfusion during cardiac operations. Lancet 14: 816-820.

Henriksen, L. (1984). Evidence suggestive of diffuse brain damage following cardiac operations. Lancet 1: 816-820.

Hirvenoja, R. (1990). The correlations between neurological and neuropsychological variables. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 389-398.

Hlatky, M. A., Bacon, C., Boothroyd, D., Mahanna, E., Reves, J. G., Newman, M. F., Johnstone, I., Winston, C., Brooks, M. M., Rosen, A. D., Mark, D. B., Pitt, B., Rogers, W., Ryan, T., Wiens, R., Blumenthal, J. A. (1997). Cognitive function 5 years after randomization to coronary angioplasty or coronary artery bypass graft surgery. Circulation 96 (9 Suppl): II-11-14; discussion II-15.

Invernizzi, G., Basile, R., Passerini, A., Calchi Novati, N., Bressi, C., Repossini, A., & Biglioli, P. (1990). The evaluation of the emotional climate in the families of cardiac surgery patients. in Impact of cardiac surgery on the quality of life: Neurological & psychological aspects. A. E. Willner, & Rodewald, G. New York: Plenum Press: 45-48.

Johnsson, P., Lundqvist, C., Lindgren, A., Ferencz, I., Alling, C., Stahl, E. (1995). Cerebral complications after cardiac surgery assessed by S-100 and NSE levels in blood. Journal of Cardiothoriac and Vascular Anesthesia 9: 694-699.

Juolasmaa, A., Outakoski, J., Hirvenoja, R., Tienari, P., Sotaniemi, K., & Takkunen, J. (1981). Effect of open-heart surgery on intellectual performance. Journal of Clinical Neuropsychology 3: 181-197.

Kilminster, S., Treasure, T., McMilan, T., & Holt, D. (1999). Neuropsychological change and S-100 protein release in 130 unselected patients undergoing cardiac surgery. Stroke 1999 (9): 1869-1874.

Klonoff, H., Clark, C., Kavansh-Gray, D., Mizgala, H., & Muno, I. (1989). Two-year follow-up study of coronary bypass surgery. Journal of Thoracic and Cardiovascular Surgery 97: 78-85.

Kolka, R., Hilberman, M., (1980). Neurologic dysfunction following cardiac operation with low-flow, low-pressure cardiopulmonary bypass. Journal of Thoracic and Cardiovascular Surgery 70, 79?: 432-437.

Lamosa, B. W. R. (1990). Correlations between psychiatric, neurological and psychometric variables: Psychiatric and psychometric issues. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 373-380.

Lee, W., H., Jr., Brady, M. P., Rowe, J. M., & Miller, W. C., (1971). Effects of extracorporeal circulation upon behavior, personality, and brain function: Part II, Hemodynamic, metabolic, and psychometric correlations. Annals of Surgery 173: 1013-1023.

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Lockwood, A. H., Benedict, R. H. B., Murphy, B. W., Chang, H. T., Gona, J., Mehrige, M., & Hussain, S. (1994). Cerebral metabolic neurobehavioral abnormalities in patients with coronary artery disease. in Cerebral Ischemia and the Heart. A. In Hartman, Hearse, D. J., & Kuschinsky, W., (Eds.): in press.

Macmanus, Q., Grunkemeier, G. L., Lambert, L. E., (1980). Year of operation as a risk factor in the late results of valve replacement. Journal of Thoracic and Cardiovascular Surgery 80: 834-841.

Mahanna, E. P., Blumenthal, J. A., White, W. D., Croughwell, N. D., Clancy, C. P., Smith, L. R., & Newman, M. F. (1996). Defining neuropsychological dysfunction after coronary artery bypass grafting. Ann of Thorac Surg. 61: 1342-1347.

Mangano, D. T. (1995). Cardiovascular morbidity and CABG surgery – a perspective: epidemiology, costs, and potential therapeutic solutions. Journal of Cardiac  Surgery 10: 366-368.

Mattlar, C. E., Knutz, L. R., Engblom, E., & Vanttinen, E. (1990). Neuropsychological findings and personality structure associated with coronary artery bypass surgery (CABS): An eight month follow-up study. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York:  Plenum: 211-220.

Mayr, N., Wolner, E., & Deecke, L. (1993). Central nervous system function after cardiopulmonary bypass. European Heart Journal, 14 (885-890).

Mckhann, G. M., Borowicz, L.. M., Goldsborough M. A. et al (1997). Depression and cognitive decline after coronary artery bypass. Lancet 349: 1282-1284.

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Mefferet, H. J., & Dahme, B. (1993). Impairment in basic cognitive functioning: attention, concentration, and mental flexibility. in Cerebral damage before and after cardiac surgery. A. E. Willner. Dordrecht, The Netherlands: Kluwer Academic Publishers: 185-194.

Meyendorf, R. (1993). The causes of pre-operative psychopathology in cardiac surgery patients. in Cerebral damage before and after cardiac surgery. A. E. Willner. Dordrecht, The Netherlands: Kluwer Academic Publishers: 3-14.

Meyerowitz, B. E., Vasterling, J., Muirhead, J., and Frist, W. (1990). Quality of life and coping in heart transplant recipients. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 471-482.

Mohr, J. P. (1979). Neurological complications of cardiac valscular disease and cardiac surgery including systemic hypotension. in Handbook of Clinical Neurology. P. J. In: Vinken, & Bruyn, G. W. (Eds.). Elsevier, North Holland: Biomedical Press. 38, Part I: 143-167.

Mora, C. T., Murkin, J. M., (1995). The central nervous system: responses to cardiopulmonary bypass. in Cardiopulmonary bypass: principles and techniques of extracorporeal circulation. C. T. In: Mora, (Ed.). New York: Springer-Verlag: 114-146.

Mora, C. T., Henson, M. B., Weintraub, W. S., et al. (1996). The effect of temperature management during cardiopulmonary bypass on neurologic and neurophysiologic outcomes in patients undergoing coronary revascularization. Journal of Thoracic and Cardiovascular Surgery 102: 546-553.

Muraoka, R., Yokota, M., Hoshima M. (1981). subclinical changes in brain morphology following cardiac operations as reflected by computed tomographic scans of the brain. Journal of Cardiothoriac and Vascular Anesthesia 81: 364-369.

Murkin, J. M., Newman, S. P., Stump, D. A., Blumenthal, J. A., (1995). Statement of consensus on assessment of neurobehavioural outcomes following cardiac surgery. Ann of Thorac Surg. 59: 1289-1295.

Naunheim, K. S., Fiore, A. C., Wadley, J. J., (1988). The changing profile of the patient undergoing coronary artery bypass surgery. J Am Coll Cardiol 11: 494-498.

Nevin, M., Colchester, A., Adams, S., & Pepper, J. R. (1989). Prediction of neurological damage after cardiopulmonary bypass surgery. Anaesthesia 44: 725-729.

Newman, M., Croughwell, N., Greeley, W., Kern, F., & Reves, J. G. (1990). Cerebral blood flow regulation during cardiopulmonary bypass: Correlation with postoperative neurologic & neuropsychologic deficits. in Impact of cardiac surgery on the quality of life: Neurologic & psychologic aspects. A. E. Willner, & Rodewald, G. (Eds.). New York: Plenum Press: 137-144.

Newman, M., Croughwell, N., Blumenthal, J. A., White, W. D., Lewis, J. B., Smith, L. R., Frasco, P., Towner, E. A., Schell, R. M., Hurwitz, B. J., et al (1994). Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction. Circulation 90 (Nov): 243-249.

Newman, M., Kramer, D., Croughwell, N. D., Sanderson, I., Blumenthal, J. A., White, W. D., Smith, L. R., Towner, E. A., Reves, J. G. (1995). Differential age effects of mean arterial pressure and rewarming on cognitive dysfunction after cardiac surgery. Anesth Analg 81 (Aug): 2236-2242.

Newman, M., Croughwell, N., Blumenthal, J. A., Lowry, E., White, W. D., Spillane, W., Davis, R. D. Jr., Glowner, D. D., Smith, L. R., Mahanna, E. P., et al (1995). Predictors of cognitive decline after cardiac operation. Ann of Thorac Surg. 59: 51326-51330.

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Newman, S., Klinger, L., Venn, G., Smith, P., Harrison, M., & Treasure, T. (1990). Reports of cognitive change, mood state and assessed cognition following coronary artery bypass surgery. in Impact of cardiac surgery on the quality of life: Neurological and psychological aspects. A. E. Willner, & Rodewald, G. (Eds.). New York. 191-200.

Newman, S., Klinger, L., Venn, G., Smith, P., Harrison, M., & Treasure, T. (1993). Neuropsychological and psychological changes. in Cardiac Surgery and the Brain. P. In: Smith, Taylor, K., (Eds.). London, UK: Edward Arnold Publishers Ltd: 34-54.

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Savageau, J. A., Stanton, B., Jenkins, D., & Klein, M. D. (1982b). Neuropsychological dysfunction following elective cardiac operation: II. A six-month reassessment. Journal of Thoracic and Cardiovascular Surgery 84: 585-594.

Sellman, M., Holm, L., Ivert, T., & Semb, B. K. H. (1993). A randomized study of neuropsychological function in patients undergoing coronary bypass surgery. Thoraic Cardiovascular Surgeon 41: 349-354.

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Shaw, P. J., Bates, D., Cartlidge, N. E. F., French, J. M., Heaviside, D., Julian, D. G., & Shaw, D. A. (1986). Early intellectual dysfunction following coronary bypass surgery. Quarterly Journal of Medicine 225: 59-68.

Shaw, P. J., Bates, D., Cartlidge, N. E. F., French, J. M., Heaviside, D., Julian, D. G., & Shaw, D. A. (1987). Long-term intellectual dysfunction following coronary artery bypass graft surgery: A six-month follow-up study. Quarterly Journal of Medicine 239: 259-268.

Shaw, P. J., Bates, D., Cartlidge, N. E. F., French, J. M., Heaviside, D., Julian, D. G., & Shaw, D. A. (1987b). Neurological and neuropsychological morbidity following major surgery: Comparison of coronary artery bypass and peripheral vascular surgery. Stroke 18: 700-707.

Slogoff, S., Girgis, K. Z., Keats, A. S., (1982). Etiologic factors in neuropsychiatric complications associated with cardiopulmonary bypass. Anesth Analg 61: 903-911.

Smith, P., Treasure, T., Newman, S., Joseph, P., Schneidau, A., Ell, P. J., Harrison, M. J. G., (1986). Cerebral consequences of cardiopulmonary bypass. Lancet 1: 823-825.

Smith, P. L. (1988). The cerebral complications of coronary artery bypass surgery. Annals of the Royal College Surgeons of England 70: 212-216.

Smith, P. L., Newman, S. P. (1993). The causes of postoperative cerebral damage. in Cerebral damage before and after cardiac surgery. A. E. Willner (Ed.) Dordrecht, The Netherlands: Kluwer Academic Publishers: 69-82.

Smith, P. L. (1995). Cerebral dysfunction after cardiac surgery: Closing address. Ann Thorac Surg 59: 1359-1362.

Smith, P. L. & Taylor, K. (Eds.) (1993). Cardiac surgery and the brain. London: Edward Arnold.

Sotaniemi, K. (1980). Brain damage and neurological outcome after open-heart surgery. J Neurol, Neurosurg, Psychiatry 43: 127-135.

Sotaniemi, K., Juolasmaa, A., & Hokkanen, E. T. (1981). Neuropsychologic outcome after open-heart surgery. Archives of Neurology 38: 2-8.

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