HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul M. Kirshbom Thomas L. Spray J. William Gaynor Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kirshbom, P. M. Articles by Gaynor, J. W. Search for Related Content PubMed PubMed Citation Articles by Kirshbom, P. M. Articles by Gaynor, J. W. Related Collections Congenital - cyanotic

J Thorac Cardiovasc Surg 2005;129:1091-1097
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection

^a Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga
^b Division of Cardiothoracic Surgery, The Childrens Hospital of Philadelphia, Philadelphia, Pa
^c Division of Cardiology, The Childrens Hospital of Philadelphia, Philadelphia, Pa
^d Division of Psychology, The Childrens Hospital of Philadelphia, Philadelphia, Pa
^e Division of Neurology, The Childrens Hospital of Philadelphia, Philadelphia, Pa
^f Division of Biostatistics and Epidemiology, The Childrens Hospital of Philadelphia, Philadelphia, Pa.

Received for publication June 8, 2004; revisions received August 10, 2004; accepted for publication August 16, 2004.

^_* Address for reprints: Paul M. Kirshbom, MD, 1365 Clifton Rd, Suite A2100, Cardiothoracic Surgery, Emory Clinic Bldg. A, At-lanta, GA 30322 (E-mail: paul_kirshbom{at}emoryhealthcare.org).

OBJECTIVE: We sought to define the neurodevelopmental status of school-aged survivors of total anomalous pulmonary venous connection repaired during infancy.

METHODS: All school-aged survivors of total anomalous pulmonary venous connection repair performed at a single institution were eligible. Thirty children returned for neurologic examination and neurodevelopmental testing.

RESULTS: The median age at total anomalous pulmonary venous connection repair was 16 days (range, 1–141 days), and age at testing was 11 years (range, 6–19 years). Pulmonary venous return was supracardiac in 14 patients, infracardiac in 12 patients, cardiac in 3 patients, and mixed in 1 patient. Preoperative obstructed total anomalous pulmonary venous connection was present in 6 patients. Circulatory arrest was used in all repairs, with a median duration of 35 minutes (range, 17–55 minutes). At follow-up, microcephaly (head circumference <5%) was present in 28%. Neuromuscular examination was suspect or abnormal in 27%. Mean Full-scale IQ (95.3 ± 18.5) and Verbal IQ (98.6 ± 20.2) were not different from population norms, but Performance IQ (92.3 ± 16.9) was significantly lower than population norms (P = .02). Fine motor skills and visual-motor coordination were significantly impaired (P < .01 for Grooved Pegboard and Test of Visual-Motor Integration). Patients with total anomalous pulmonary venous connection also had difficulty with tests of attention (Test of Everyday Attention for Children, P < .01), but results of tests of memory function were not significantly different from population norms.

CONCLUSIONS: School-aged survivors of infant total anomalous pulmonary venous connection repair exhibit a significant incidence of neurodevelopmental difficulties. Fine motor function, visual-motor integration, and attention are the most commonly affected domains. Evaluation of these children is indicated to identify those who are at risk for learning disabilities and who could benefit from early intervention.

This article has been cited by other articles:

				M. S. Gould, B. T. Walsh, J. L. Munfakh, M. Kleinman, N. Duan, M. Olfson, L. Greenhill, and T. Cooper Sudden Death and Use of Stimulant Medications in Youths Am J Psychiatry, September 1, 2009; 166(9): 992 - 1001. [Abstract] [Full Text] [PDF]

				J. Conway, K. K. Wong, C. O'Connell, and A. E. Warren Cardiovascular Risk Screening Before Starting Stimulant Medications and Prescribing Practices of Canadian Physicians: Impact of the Health Canada Advisory Pediatrics, October 1, 2008; 122(4): e828 - e834. [Abstract] [Full Text] [PDF]

				V. L. Vetter, J. Elia, C. Erickson, S. Berger, N. Blum, K. Uzark, and C. L. Webb Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing Circulation, May 6, 2008; 117(18): 2407 - 2423. [Full Text] [PDF]

				A. J. Shillingford, M. M. Glanzman, R. F. Ittenbach, R. R. Clancy, J. W. Gaynor, and G. Wernovsky Inattention, Hyperactivity, and School Performance in a Population of School-Age Children With Complex Congenital Heart Disease Pediatrics, April 1, 2008; 121(4): e759 - e767. [Abstract] [Full Text] [PDF]

				G. Wernovsky Improving neurologic and quality-of-life outcomes in children with congenital heart disease: Past, present, and future J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 240 - 242. [Full Text] [PDF]

				D. E. Creighton, C. M.T. Robertson, R. S. Sauve, D. M. Moddemann, G. Y. Alton, A. Nettel-Aguirre, D. B. Ross, I. M. Rebeyka, and and the Western Canadian Complex Pediatric Therapi Neurocognitive, Functional, and Health Outcomes at 5 Years of Age for Children After Complex Cardiac Surgery at 6 Weeks of Age or Younger Pediatrics, September 1, 2007; 120(3): e478 - e486. [Abstract] [Full Text] [PDF]

				M. G. McBride, P. M. Kirshbom, J. W. Gaynor, R. F. Ittenbach, G. Wernovsky, R. R. Clancy, T. B. Flynn, D. M. Hartman, T. L. Spray, R. E. Tanel, et al. Late cardiopulmonary and musculoskeletal exercise performance after repair for total anomalous pulmonary venous connection during infancy J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1533 - 1539. [Abstract] [Full Text] [PDF]

				G. Y. Alton, C. M.T. Robertson, R. Sauve, A. Divekar, A. Nettel-Aguirre, S. Selzer, A. R. Joffe, I. M. Rebeyka, D. B. Ross, and Western Canadian Complex Pediatric Therapies Proje Early childhood health, growth, and neurodevelopmental outcomes after complete repair of total anomalous pulmonary venous connection at 6 weeks or younger J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 905 - 911. [Abstract] [Full Text] [PDF]

				G. D. Williams and C. Ramamoorthy Brain monitoring and protection during pediatric cardiac surgery. Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2007; 11(1): 23 - 33. [Abstract] [PDF]

				M. A. Padula and A. M. Ades Neurodevelopmental Implications of Congenital Heart Disease NeoReviews, July 1, 2006; 7(7): e363 - e369. [Full Text] [PDF]