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J Thorac Cardiovasc Surg 2007;133:449-455
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Intellectual, neuropsychological, and behavioral functioning in children with tetralogy of Fallot

^a Laboratory for Neuropsychology, Department of Internal Medicine, Ghent University, Ghent, Belgium.
^b Paediatric Cardiology, Department of Paediatrics, Ghent University, Ghent, Belgium.
^c Paediatric Cardiac Surgery, Department of Surgery, Ghent University, Ghent, Belgium.
^d Reference Centre for Refractory Epilepsy, Ghent University, Ghent, Belgium.

Received for publication August 22, 2006; revisions received September 29, 2006; accepted for publication October 10, 2006.

^_* Address for reprints: Miatton Marijke, Dpsych, Laboratory for Neuropsychology, Ghent University, De Pintelaan 185, 4 K 3, B-9000 Ghent, Belgium. (Email: marijke.miatton{at}ugent.be).

OBJECTIVE: Although it is known that pediatric cardiac surgery holds risks for later development, few studies investigated the long-term development in children with tetralogy of Fallot. The purpose of this study was to define their intellectual capacities, neuropsychological profile, and behavioral functioning 6 to 12 years postoperatively.

METHODS: Patients (n = 18; age, 8 years, 3 months ± 1 year, 6 months) were examined with a short-form intelligence scale (Wechsler Intelligence Scale for Children, 3rd edition, Dutch version) and a neuropsychological assessment battery (NEPSY). Their parents completed a behavioral questionnaire. The patient group was compared with an acyanotic congenital heart disease group and a healthy control group.

RESULTS: No significant differences between the patient group and the acyanotic group emerged. Compared with the healthy control group, children with tetralogy of Fallot showed significantly lower scores on the estimated Full Scale IQ (P < .05) and on the NEPSY domains Language (P < .01) and Sensorimotor Functioning (P < .01). Also, the subtests Tower (P < .05), Memory for Names (P < .05), Narrative Memory (P < .05), and Design Copy (P < .05) elicited group differences. Parental reports revealed significantly higher scores on attention problems (P < .05) and the total problem scale (P < .05), as well as significantly lower school performances than those of healthy peers (P < .01).

CONCLUSIONS: In children with tetralogy of Fallot, we identified a lower estimated full-scale intelligence than in healthy peers and a neuropsychological profile characterized by primarily mild motor deficits and difficulties with language tasks. Parents of the children with tetralogy of Fallot indicated attention problems and rated the child’s school competencies to be lower than in healthy control subjects.