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J Thorac Cardiovasc Surg 1997;114:578-585
© 1997 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
Supported by grants of "Land Nordrhein-Westfalen" and "Bundesverband Herzkrankes Kind e.V.," Germany.
Received for publication Nov. 7, 1996 revisions requested Jan. 2, 1997; revisions received May 5, 1997 accepted for publication May 6, 1997. Address for reprints: H. H. Hövels-Gürich, MD, Department of Pediatric Cardiology, RWTH Aachen, Pauwelsstr. 30, D-52057 Aachen, Germany.
Abstract
Objective: The developmental status of children beyond 3 years of age after the neonatal arterial switch operation has not yet been systematically evaluated and is the topic of the present work. Methods: Seventy-seven unselected children operated on as neonates with combined deep hypothermic circulatory arrest and low-flow cardiopulmonary bypass were examined at an age of 3.2 to 9.4 years (5.4 ± 1.6 years, mean ± standard deviation). Clinical neurologic status, standard scores of intelligence, acquired abilities and vocabulary, and standardized tests on gross motor and fine motor functions were carried out, and the results were related to preoperative, perioperative, and postoperative status and management. Results: Neurologic impairment was more frequent (9.1%) than in the normal population. Intelligence was not different in these patients compared with normal children (p = 0.11), but motor function, vocabulary, and acquired abilities were poorer. Reduced intelligence was found in 9.1%, fine motor dysfunction in 22.1%, and gross motor dysfunction in 23.4% of the children. Intelligence was weakly but significantly inversely related to the duration of bypass (Spearman correlation coefficient –0.25, p = 0.03) and tended to be inversely related to the duration of circulatory arrest (–0.21, p = 0.07), but not to core cooling time on bypass or degree of hypothermia. Gross motor function, vocabulary, and acquired abilities were not significantly related to any of the perioperative parameters considered. No correlation was found between the test results and the variables perinatal asphyxia, perioperative and postoperative cardiocirculatory insufficiency, resuscitation events, and plexal or intraventricular cerebral hemorrhage. Conclusions: The neonatal arterial switch operation with combined circulatory arrest and low-flow bypass in our experience is associated with neurologic as well as fine and gross motor impairment but appears to be well tolerated concerning cognitive functions as based on formal intelligence testing.
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