title: Neurologic and psycho-intellectual outcome related to structural brain imaging in adolescents and young adults after neonatal arterial switch operation for transposition of the great arteries.
abstract: OBJECTIVE
  We studied brain structure abnormalities in adolescents and young adults who had undergone the neonatal arterial switch operation for transposition of the great arteries and related them to the neurologic and psycho-intellectual outcomes.
  
  
  METHODS
  In a prospective longitudinal study, 60 unselected adolescents and young adults who had undergone surgery with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were re-evaluated at a mean age of 16.9±1.7 years to determine their clinical neurologic status, intellectual development, and psychological condition. The results were related to population norms and anatomic structural abnormalities assessed by brain magnetic resonance imaging, with consideration of the risk factors in the preoperative and perioperative periods.
  
  
  RESULTS
  Neurologic impairment was more frequent (10%) than in the normal population. Although the average full-scale, verbal, and performance intelligence quotients were not reduced, scores>2 standard deviations less than the expected mean were increased. Above average scores were found for analytical thinking, but the orthography testing results were reduced. The self-rated psychological condition was better than expected. Magnetic resonance imaging demonstrated moderate or severe structural brain abnormalities in 32% of the patients. Periventricular leukomalacia was detected in >50%; its severity correlated with the grade of neurologic impairment, which correlated significantly with reduced intelligence, analytical thinking, and orthography. Preoperative acidosis and hypoxia were the only independent patient-related risk factors for neurologic dysfunction, reduced intelligence, periventricular leukomalacia, and reduced brain volume.
  
  
  CONCLUSIONS
  Despite encouraging overall neurodevelopmental outcomes, a significant minority had performances below the expected level, emphasizing the need for ongoing surveillance. Considering the high frequency of structural brain abnormalities, prospective long-term studies are needed to define their prognostic value with respect to the neuropsychological outcomes in childhood and adolescence.
authors.affiliation: Department of Pediatric Cardiology, University Hospital, Aachen University of Technology, Aachen, Germany.
authors.forename: Anna Kathrin M
authors.initials: AK
authors.lastname: Heinrichs
authors.affiliation: Department of Pediatric Cardiology, University Hospital, Aachen University of Technology, Aachen, Germany.
authors.forename: Annika
authors.initials: A
authors.lastname: Holschen
authors.affiliation: Department of Neuroradiology, University Hospital, Aachen University of Technology, Aachen, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital, Aachen University of Technology, Aachen, Germany.
authors.forename: Bruno J
authors.initials: BJ
authors.lastname: Messmer
authors.affiliation: Department of Central Service Facility "Functional Imaging" at the ICCR-Biomat, University Hospital, Aachen University of Technology, Aachen, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Schnitker
authors.affiliation: Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Minkenberg
authors.affiliation: Department of Pediatric Cardiology, University Hospital, Aachen University of Technology, Aachen, Germany. Electronic address: hhoevels-guerich@ukaachen.de.
authors.forename: Hedwig H
authors.initials: HH
authors.lastname: Hövels-Gürich
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D041923:Adolescent Development; D000367:Age Factors; D001921:Brain / Q000254:growth & development / Q000473:pathology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007360:Intelligence; D007361:Intelligence Tests; D007969:Leukomalacia, Periventricular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult