Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-27T00:02:06.676Z Has data issue: false hasContentIssue false
  • English
  • Français

Predictors of developmental outcomes in children with complete transposition

Published online by Cambridge University Press:  19 August 2008

Alex Gomelsky ,
E. Wayne Holden ,
Kathy A. Ellerbeck  and
Joel I. Brenner
Alex Gomelsky
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
E. Wayne Holden
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
Kathy A. Ellerbeck
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
Joel I. Brenner*
Affiliation:
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
*
Dr Joel I. Brenner, University of Maryland Medical System, 22 S. Greene Street, N5W4O, Baltimore, MD 21201, USA. Tel 410 328 6666; Fax: 410 328 8670
Get access Rights & Permissions [Opens in a new window]

Abstract

Cognitive, functional, educational achievement and behavioural measures were employed to assess neurobehavioral status in 57 of 60 participants who were initially enrolled in the Baltimore–Washington Infant Study, and who survived surgical correction of complete transposition (concordant atrioventricular and discordant ventriculo-arterial connections). Charts were reviewed to investigate the relationship between birth variables, surgical strategy and developmental outcomes. Higher preoperative weight was associated with better outcomes on the Stanford–Biner Short-term Memory subtest, while lower preoperative oxygen tension was associated with better outcomes on the Abstract/Visual Reasoning subtest and a test of Visual–Motor Integration. Longer total bypass time was associated with poor outcomes on the Short-term Memory subtests. Higher average flow rates during cooling and rewarming were associated with higher scores in the test of short term memory but poorer outcomes on a test for visual motor integration. Longer cooling times were associated with higher scores on the test for Visual–Motor Integration. Patients suffering seizures scored lower on the Stanford–Biner Composite, as well as in their tests of achievement. The data indicate that non-verbal. skills may be particularly sensitive to variations in surgical strategies employed to correct complete transposition. Overt neurological events, such as seizures, were related to global deficits in intellectual functioning. Prospective studies evaluating systemic variations in surgical procedures and attempts to prevent and manage perioperative neurological events are important for further investigation of neurodevelopmental outcomes in children surviving surgical correction.

Keywords

Transposition of the great arteriesdevelopmental outcome
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 3 , July 1998 , pp. 352 - 357
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Veelken, N, Gravinghoff, L, Keck, EW, Freitag, HJ. Improved neurological outcome following following early anatomical correction of transposition of the great arteries. Clin Cardiol 1992;15: 275–279.CrossRefGoogle ScholarPubMed
2.Kirklin, JW, Colvin, EV, McConnell, ME, Bargeron, LM Jr. Complete transposition of the great arteries; treatment in the current era. Ped Clin N Am 1990; 37: 171–177.CrossRefGoogle ScholarPubMed
3.Williams, WG, Trusler, GA, Kirklin, JW, Blackstone, EH, Coles, JG, Izukawa, T, Freedom, RM. Early and late results of a protocol for simple transposition leading to an atrial switch (Mustard) repair. J Thorac Cardiovasc Surg 1988;95: 717–726.CrossRefGoogle Scholar
4.Turley, K, Verrier, ED. Intermediate results from the period of the Congenital Heart Surgeons Transposition Study: 1985 to 1989. Congenital Heart Surgeons Society Database. Ann Thorac Surg 1995;60: 505–510.CrossRefGoogle ScholarPubMed
5.Wernovsky, G, Mayer, JE Jr, Hanley, FL, Blackstone, EH, Kirklin, JW, Castaneda, AR. Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 1995; 109:289–301.CrossRefGoogle ScholarPubMed
6.O'Dougherty, M, Wright, FS, Garmezy, N, Loewenson, RB, Torres, F. Later compertence and adaptation in infants who survive severe heart defects. Child Dev 1983; 54: 1129–1142.CrossRefGoogle ScholarPubMed
7.O'Dougherty, M, Wright, FS, Loewenson, RB, Torres, F. Cerebral dysfunction after chronic hypoxia in children. Neurology 1985; 35: 42–46.CrossRefGoogle ScholarPubMed
8.O'Dougherty, M, Nuechterlein, KH, Drew, B. Hyperactive and hypoxic children: signal detection, sustained attention, and behavior. J Abn Phychol 1984; 93: 178–191.CrossRefGoogle ScholarPubMed
9.Aisenberg, RB, Rosenthal, A, Wolff, PH, Nadas, AS. Hypoxemia and critical flicker frequency in congenital heart disease. Am J Dis Child 1974; 128: 335–338.Google ScholarPubMed
10.Aisenberg, RB, Rosenthal, A, Nadas, AS, Wolff, PH. Developmental delay in infants with congenital heart disease. Correlation with hypoxemia and congestive heart failure. Ped Card 1982; 3: 133–137.Google ScholarPubMed
11.Newburger, JW, Silbert, AR, Buckley, LP, Fyler, CD. Cognitive function and age at repair of transposition of the great arteries in children. New Engl J Med 1984; 310: 1495–1499.CrossRefGoogle ScholarPubMed
12.Aram, DM, Ekelman, BL, Ben-Shachar, G, Levinsohn, MW. Intelligence and hypoxemia in children with congenital heart disease: fact or artifact? J Am Coll Card 1985; 6: 889—893.CrossRefGoogle ScholarPubMed
13.Kramer, HH, Awiszus, D, Sterzel, U, van Halteren, A, Classen, R. Development of personality and intelligence in children with congenital heart disease. J Child Psychol Psychiatry Allied Discip 1989; 30: 299–308.CrossRefGoogle ScholarPubMed
14.Hesz, N, Clark, EB. Cognitive development in transposition of the great vessels. Arch Dis Child 1988; 63: 198–200.CrossRefGoogle ScholarPubMed
15.Silbert, A, Wolff, PH, Mayer, B, Rosenthal, A, Nadas, AS. Cyanotic heart disease and psychological development. Pediatrics 1969;43:192–200CrossRefGoogle ScholarPubMed
16.Bellinger, DC, Wernovsky, G, Rappaport, LA, Mayer, JE, Castaneda, AR, Farrell, DM, Wessel, DL, Lang, P, Hickey, PR, Jonas, RA, Newburger, JW. Cognitive development of children following early repailr of transposition of the great arteries using deep hypothermic circulatory arrest. Pediatrics 1991; 87: 701–707.CrossRefGoogle ScholarPubMed
17.Ferencz, C, Rubin, JD, Loffredo, CA, Magee, CA(eds). Epidemiology of Congenital Heart Disease: The Baltimore–Washigton Infant Study, 1981–1989. Futura, New York.Google Scholar
18.Thorndike, RL, Hagen, EP, Sattler, JM. Stanford–Binet Intelligence Scale, 4th edn. Riverside, Chicago, 1986.Google Scholar
19.Woodcock, RW, Johnson, MB. Woodcock–Johnson Psychoeducational Battery Revised. DLM Teaching Resources, Allen, 1990.Google Scholar
20.AUTHOR TO SUPPLYGoogle Scholar
21.Beery, E. Developmental Test of Visual– Motor Integration. Western Psychological Services, Los Angeles, 1989.Google Scholar
22.Ellerbeck, K, Smith, M, Holden, EW, McMenamin, S, Badawi, M, Brenner, JI, Kan, J, Hyman, S. Neurodevelopmental outcomes in childern surviving d-transposition of the great arteries (sub-mitted).Google Scholar
23.Jonas, RA, Bellinger, DC, Rappaport, LA, Wernovsky, G, Hickey, PR, Farrell, DM, Newburger, JW. Relation of pH strategy and developmental outcome after hypothermic circulatory arrest. J Thorac Cardiovasc Surg 1993;106:362–368.CrossRefGoogle ScholarPubMed
24.Newburger, JW, Jonas, RA, Wernovsky, G, Wypij, D, Hickey, PR, Kuban, KC, Farrell, DM, Holrnes, GL, Helmers, SL, Constantinou, J, Carrazana, E, Barlow, JK, Walsh, AZ, Lucius, KC, Share, JC, Wessel, DL, Hanley, FL, Mayer, JE Jr, Castaneda, AR, Ware, JH. A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow car-diopulmonary bypass in infant heart surgery. New Engl J Med 1993; 329: 1057–1064.CrossRefGoogle Scholar
25.Bellinger, DC, Jonas, RA, Rappaport, LA, Wypij, D, Wernovsky, G, Kuban, KC, Barnes, PD, Holmes, GL, Hickey, PR, Strand, RD, Walsh, AZ, Helmers, SL, Constantinou, JE, Carrazana, EJ, Mayer, JE Jr, Hanley, FL, Castaneda, AR, Ware, JH, Newburger, JW. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low–flow cardiopulmonary bypass. New Engl J Med 1995; 32: 549–555.CrossRefGoogle Scholar
26.Wells, F, Coghill, S, Caplan, H, Lincoln, C. Duration of circulatory arrest does influence the psychological development of children after cardiac operations in early life. J Thorac Cardiovasc Surg 1983; 86: 823–831.CrossRefGoogle ScholarPubMed
27.Wright, J, Hicks, R, Newman, D. Deep hypothermic arrest: observations on later developments in children. J Thorac Cardiovasc Surg 1979; 77: 466–469.CrossRefGoogle ScholarPubMed
28.Kirklin, J, Barratt-Boyes, B(eds). Cardiac Surgery. John Wiley and Sons, New York, 1986.Google Scholar
29.Settergren, G, Ohqvist, G, Lundberg, S, Henze, A, Bjork, VO, Persson, B. Cerebral blood flow and cerebral metabolism in children following cardiac surgery with deep hypothermia and circulatory arrest: clinical course and follow-up of psychomotor development. Scand J Thorac Cardiovasc Surg 1982; 16: 209–215.CrossRefGoogle ScholarPubMed
30.Dickenson, D, Sambrooks, J. Intellectual performance in children after circulatory arrest with profound hypothermia in infancy. Arch Dis Child 1979; 54: 1–6.CrossRefGoogle Scholar
31.Clarkson, P, Macarthur, B, Barrett–Boyes, B, Whitlock, R, Neutze, J. Developmental progress after cardiac surgery in infancy using hypothermia and circulatory arrest. Circulation 1980; 62: 855–861.CrossRefGoogle ScholarPubMed
32.Richter, J. Profound hypothermia and circulatory arrest: studies on intraoperative metabolic changes and late postoperative development after correction of congenital heart disease. In Delange, S, Hennis, P, Kettler, D, Dordrecht, D (eds), Cardiac Anesthesia: Problems, Innovations. Nijhoff, New York, 1986.Google Scholar