Neurodevelopmental outcomes after biventricular repair of congenital heart defects.
OBJECTIVE
This study was undertaken to assess neurodevelopment of children after biventricular repair of congenital heart defects.


METHODS
Full-scale, performance, and verbal IQs of 69 patients who had undergone biventricular repair were assessed at 5 years of age with the Wechsler Preschool and Primary Scales of Intelligence-Revised. The Wide Range Assessment of Visual-Motor Abilities was used to measure visual-motor skills. Regression analyses adjusting for parental IQ and socioeconomic status were used to evaluate outcome predictors.


RESULTS
Median age at repair was 91 days (range 1-1558 days). Hypothermic circulatory arrest was used in 35 cases (mean duration of hypothermic circulatory arrest 33 +/- 17 minutes). Mean full-scale, performance, and verbal IQs for the entire study population were within the reference range (full-scale 96.9 +/- 15.9, performance 96.6 +/- 16.8, verbal 97.7 +/- 15.2). Anatomic diagnosis, age at operation, and use of hypothermic circulatory arrest did not influence full-scale IQ (P =.66, P =.14, and P =.46, respectively), performance IQ (P =.64, P =.36, and P =.73, respectively), or verbal IQ (P =.74, P =.08, and P =.39, respectively). Among patients subjected to hypothermic circulatory arrest, duration of arrest was evaluated as a predictor of outcome. After adjustment for parental IQ, full-scale (P =.12), performance (P =.07), and verbal (P =.22) IQ scores of patients with more than 39 minutes of hypothermic circulatory arrest were not different from those of patients who had arrest periods of 39 minutes or less. After adjustment for socioeconomic status, however, full-scale (P =.05) and performance (P =.03) IQ scores were lower among patients who had more than 39 minutes of hypothermic circulatory arrest. After adjustment for either parental IQ or socioeconomic status, patients with more than 39 minutes of arrest had lower scores on Wide Range Assessment of Visual-Motor Abilities subtests of visual-motor and fine motor abilities and on several performance IQ subtests.


CONCLUSIONS
IQs of patients who had undergone biventricular repair of congenital heart defects were within the reference range. However, hypothermic circulatory arrest for longer than 39 minutes was associated with deficits in visual-motor and fine motor skills and possibly in full-scale IQ.
Forbess
Joseph M
JM
Departments of Cardiovascular Surgery and Neuroepidemiology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. forbess@cardio.tch.harvard.edu
Visconti
Karen J
KJ
Bellinger
David C
DC
Howe
Robert J
RJ
Jonas
Richard A
RA
D001900:Boston / Q000453:epidemiology; D013504:Cardiovascular Surgical Procedures; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D007036:Hypothermia, Induced; D007360:Intelligence / Q000502:physiology*; D008297:Male; D011237:Predictive Value of Tests; D011597:Psychomotor Performance / Q000502:physiology; D012307:Risk Factors; D012959:Socioeconomic Factors; D013037:Spatial Behavior / Q000502:physiology; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome