title: Adolescents with d-transposition of the great arteries corrected with the arterial switch procedure: neuropsychological assessment and structural brain imaging.
abstract: BACKGROUND
  We report neuropsychological and structural brain imaging assessments in children 16 years of age with d-transposition of the great arteries who underwent the arterial switch operation as infants. Children were randomly assigned to a vital organ support method, deep hypothermia with either total circulatory arrest or continuous low-flow cardiopulmonary bypass.
  
  
  RESULTS
  Of 159 eligible adolescents, 139 (87%) participated. Academic achievement, memory, executive functions, visual-spatial skills, attention, and social cognition were assessed. Few significant treatment group differences were found. The occurrence of seizures in the postoperative period was the medical variable most consistently related to worse outcomes. The scores of both treatment groups tended to be lower than those of the test normative populations, with substantial proportions scoring ≥1 SDs below the expected mean. Although the test scores of most adolescents in this trial cohort are in the average range, a substantial proportion have received remedial academic or behavioral services (65%). Magnetic resonance imaging abnormalities were more frequent in the d-transposition of the great arteries group (33%) than in a referent group (4%).
  
  
  CONCLUSIONS
  Adolescents with d-transposition of the great arteries who have undergone the arterial switch operation are at increased neurodevelopmental risk. These data suggest that children with congenital heart disease may benefit from ongoing surveillance to identify emerging difficulties.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000470.
authors.affiliation: Department of Neurology, Harvard Medical School, Boston, MA 02115, USA. david.bellinger@childrens.harvard.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Bellinger
authors.forename: David
authors.initials: D
authors.lastname: Wypij
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rivkin
authors.forename: David R
authors.initials: DR
authors.lastname: DeMaso
authors.forename: Richard L
authors.initials: RL
authors.lastname: Robertson
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dunbar-Masterson
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Rappaport
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
mesh_terms: D000293:Adolescent; D001288:Attention / Q000502:physiology; D001921:Brain / Q000033:anatomy & histology / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000534:rehabilitation* / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000534:rehabilitation* / Q000706:statistics & numerical data; D002648:Child; D003071:Cognition / Q000502:physiology*; D004522:Educational Status; D056344:Executive Function / Q000502:physiology; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods / Q000534:rehabilitation* / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods / Q000706:statistics & numerical data; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods; D008568:Memory / Q000502:physiology; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000453:epidemiology; D011597:Psychomotor Performance / Q000502:physiology; D012307:Risk Factors; D012919:Social Behavior; D014188:Transposition of Great Vessels / Q000453:epidemiology / Q000534:rehabilitation* / Q000601:surgery