Delayed Paraparesis: An Unusual Complication Following Coarctation of Aorta Repair

Paraparesis, or lower limb weakness, following heart surgery can indicate spinal cord injury (SCI). This risk exists when the aorta is clamped, such as during coarctation of the aorta (CoA) repair. While the risk is low, it can significantly impact the patient's health. This report describes a case where a child developed paraparesis five days after CoA repair. The report highlights potential risk factors and ways to protect the spinal cord during aortic surgeries. The delay in onset, up to 21 days post-surgery, may be due to biochemically mediated reperfusion injury. Understanding this mechanism is vital, even when standard precautions are taken.

• 1
  The patient developed bilateral lower limb weakness on postoperative day 5, with MRI showing signs of ischemic insult to the cauda equina nerve roots.
• 2
  Factors potentially contributing to the delayed SCI included increased clamp time (35 minutes), decreased collateralization, the presence of PDA, and VSD repair requiring CPB.
• 3
  Post-operative neurological monitoring is crucial for early recognition of complications, enabling timely intervention and potentially improving outcomes.