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Long-term neurodevelopmental effects of intraoperative blood pressure during surgical closure of a septal defect in infancy or early childhood

Part of: Ventricular Septal Defect (VSD) Surgery Atrial Septal Defect (ASD)

Published online by Cambridge University Press:  12 April 2021

Daniel J. Lauritzen Open the ORCID record for Daniel J. Lauritzen [Opens in a new window] ,
Benjamin Asschenfeldt Open the ORCID record for Benjamin Asschenfeldt [Opens in a new window] ,
Lars Evald ,
Vibeke E. Hjortdal  and
Johan Heiberg Open the ORCID record for Johan Heiberg [Opens in a new window]
Daniel J. Lauritzen*
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Benjamin Asschenfeldt
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Lars Evald
Affiliation:
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
Vibeke E. Hjortdal
Affiliation:
Department of Cardiothoracic Surgery, Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
Johan Heiberg
Affiliation:
Department of Anesthesiology, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
*
Author for correspondence: D. J. Lauritzen, MD, Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200AarhusN, Denmark. Tel: +45 41817574; Fax: +45 7845 3079. E-mail: [email protected]
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Abstract

Background:

Many children born with congenital heart defects are faced with cognitive deficits and psychological challenges later in life. The mechanisms behind are suggested to be multifactorial and are explained as an interplay between innate and modifiable risk factors. The aim was to assess whether there is a relationship between mean arterial pressure during surgery of a septal defect in infancy or early childhood and intelligence quotient scores in adulthood.

Methods:

In a retrospective study, patients were included if they underwent surgical closure of a ventricular septal defect or an atrial septal defect in childhood between 1988 and 2002. Every patient completed an intelligence assessment upon inclusion, 14–27 years after surgery, using the Wechsler Adult Intelligence Scale Version IV.

Results:

A total of 58 patients met the eligibility criteria and were included in the analyses. No statistically significant correlation was found between blood pressure during cardiopulmonary bypass and intelligence quotient scores in adulthood (r = 0.138; 95% CI−0.133–0.389). Although amongst patients with mean arterial pressure < 40 mmHg during cardiopulmonary bypass, intelligence quotient scores were significantly lower (91.4; 95% CI 86.9–95.9) compared to those with mean arterial pressure > 40 mmHg (99.8; 95% CI 94.7–104.9).

Conclusions:

Mean arterial pressure during surgery of ventricular septal defects or atrial septal defects in childhood does not correlate linearly with intelligence quotient scores in adulthood. Although there may exist a specific cut-off value at which low blood pressure becomes harmful. Larger studies are warranted in order to confirm this, as it holds the potential of partly relieving CHD patients of their cognitive deficits.

Keywords

Atrial septal defectcardiopulmonary bypass managementneurodevelopmentpaediatricsventricular septal defect
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 2002 - 2008
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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