Post-pump chorea (PPC) is a complication of major heart surgery and usually occurs in children. It causes involuntary and uncontrollable movements.
PPC is a movement disorder that occurs due to nerve cell dysfunction. It is a rare complication of open-heart surgery in children, particularly if the surgery involves deep hypothermia. It is very uncommon for PPC to occur in adults, but it is possible.
PPC may cause people to have involuntary, sudden, jerky movements. Symptoms may occur a few days after having major heart surgery.
This article looks at the symptoms, causes, and diagnosis of PPC, as well as treatment and outlook.
PPC is a neurologic condition that can occur as a complication of major heart surgery. A neurologic condition affects the nervous system, including the brain and spinal cord.
Chorea is a movement disorder that causes sudden, involuntary movements. Chorea occurs
PPC is a chorea that occurs as a complication of heart surgery. PPC is a rare condition and usually occurs in children. PPC may completely resolve within months. PPC is very rare in adults.
PPC may occur as a complication of major heart surgery and cardiopulmonary bypass. Cardiopulmonary bypass is a procedure that helps support open-heart surgery and uses a heart-lung machine to carry out the normal function of the heart and lungs. The heart-lung machine supplies oxygenated blood to the body while people are having surgery.
The bypass machine and the dance-like movements of chorea give PPC its name. Another phrase for having had a cardiopulmonary bypass is being “on the pump.” And the term “chorea” is Greek for “dance-like.”
PPC causes people to have involuntary and uncontrollable movements. Symptoms of PPC may include:
- sudden, jerky movements of the legs, arms, and face
- movements that look as though a person is fidgeting, restless, or clumsy
- irregular and unpredictable movements
Movements may include:
- dance-like motions
- squeezing and releasing the fingers when shaking a person’s hand
- moving the tongue in and out of the mouth
To diagnose PPC, doctors will assess a person’s symptoms and medical history. Doctors may use a range of tests to rule out other possible causes. These may include:
Doctors may also look for other factors that can increase the risk of chorea,
PPC may occur as a rare complication of open-heart surgery and cardiopulmonary bypass.
Risk factors for PPC include circulatory arrest and prolonged, deep hypothermia (DH). Doctors
Research suggests that hypothermia with surgery may cause reversible metabolic damage in the basal ganglia in the brain, which may lead to PPC. DH may affect blood flow to the brain, which may cause nerve cell damage, resulting in chorea.
PPC is rare in adults but may occur due to prolonged circulatory arrest in lengthy surgeries. Certain medications may link to movement disorders, including midazolam and fentanyl. Fentanyl for anesthesia during surgery may play a role in PPC.
Doctors may use the following medications to treat chorea in children:
- dopamine-depleting drugs, such as tetrabenazine or reserpine
- typical antipsychotics, such as haloperidol, pimozide, or chlorpromazine
- atypical antipsychotics, such as risperidone
- anticonvulsant drugs, such as valproic acid, carbamazepine
- benzodiazepines, such as clonazepam
Adults may receive similar medications. In a 2022 case study, tetrabenazine effectively controlled almost all PPC symptoms in a 28-year-old female. The person was able to stop taking tetrabenazine after 6 months.
In a 2020 case study, treatment with haloperidol, tetrabenazine, and clonazepam resulted in a gradual easing of PPC symptoms until the condition completely resolved in 1 month.
Treatment with medications may cause side effects. People can discuss any possible risks or side effects of medications with a doctor.
Deep brain stimulation is a treatment method for various movement disorders and may be a treatment option for medication-insensitive or prolonged chorea.
Deep brain stimulation is a surgical procedure that involves implanting electrodes into the brain and a small electrical generator into the chest. Deep brain stimulation delivers pulses of mild electrical current to the brain.
Deep brain stimulation may help interrupt dysfunctional signals, which cause the movement symptoms of PPC.
PPC is a rare complication of major heart surgery, particularly with the involvement of DH. PPC usually occurs in children and rarely in adults.
PPC occurs due to a nervous system disorder. Changes in normal signaling in the brain cause abnormal movements. Symptoms of PPC include involuntary, jerky movements, which may occur a few days after surgery.
Treatment for PPC may help relieve symptoms. Treatment may include medications or, in some cases, deep brain stimulation. The outlook may vary in each individual case, but in many cases, PPC may resolve with treatment.