Neurodevelopmental outcome after early repair of a ventricular septal defect with or without aortic arch obstruction.
OBJECTIVE
Cross-sectional studies of intermediate-term survivors of infant cardiac surgery have revealed a high frequency of neurodevelopmental disabilities. Few data exist regarding neurodevelopmental outcome of infants undergoing surgical intervention for a ventricular septal defect. The purpose of this study was to evaluate the neurodevelopmental outcome at 1 year of age of children who had surgical repair in infancy of a ventricular septal defect or a ventricular septal defect with aortic arch obstruction.


METHODS
Children who underwent repair of a ventricular septal defect or single-stage repair of a ventricular septal defect with aortic arch obstruction at less than 6 months of age were assessed at 1 year of age by using the Bayley Scales of Infant Development II, which yields the Mental Development Index and the Psychomotor Development Index, both with an expected mean of 100 +/- 15.


RESULTS
At 1 year, 55 patients (ventricular septal defect alone = 36; ventricular septal defect with aortic arch obstruction = 19) returned for evaluation. The mean Mental Development Index was 92.6 +/- 11.7, with 3 (5%) patients scoring 70 or less. The mean Psychomotor Development Index was 86.1 +/- 16.4, with 10 (18%) patients scoring 70 or less. Patients with a suspected or confirmed genetic syndrome had both a lower Mental Development Index score (P = .011) and a lower Psychomotor Development Index score (P = .001). Mental Development Index and Psychomotor Development Index were independent of anatomic (specifically aortic arch obstruction) and intraoperative factors (specifically deep hypothermic circulatory arrest).


CONCLUSIONS
Neurodevelopmental outcome at 1 year of age was within the normal limits for most patients who underwent repair of a ventricular septal defect or a ventricular septal defect with aortic arch obstruction during infancy.
Kaltman
Jonathan R
JR
Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. kaltman@email.chop.edu
Jarvik
Gail P
GP
Bernbaum
Judy
J
Wernovsky
Gil
G
Gerdes
Marsha
M
Zackai
Elaine
E
Clancy
Robert R
RR
Nicolson
Susan C
SC
Spray
Thomas L
TL
Gaynor
J William
JW
D001015:Aortic Arch Syndromes / Q000453:epidemiology*; D015897:Comorbidity; D002658:Developmental Disabilities; D006345:Heart Septal Defects, Ventricular / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D015999:Multivariate Analysis; D011597:Psychomotor Performance