A total of 114 children (51 with tetralogy of Fallot, 30 with transposition of the great arteries, and 33 with ventricular septal defect) who had these defects repaired with the use of deep hypothermia and circulatory arrest were assessed for intellectual and neuropsychologic function at an average of 9 to 10 years after the operation. Children with preoperative intellectual handicaps or postoperative neurologic complications were excluded. These children were compared with 54 who had atrial septal defects repaired with the use of cardiopulmonary bypass. The only significant difference in the neuropsychologic measures was that the bypass group had reaction times 2 to 3 seconds shorter on average than those of the hypothermic circulatory arrest group. Although there was no significant difference in intelligence quotient between the groups, a relationship between intelligence quotient and arrest time was found. Regression analysis of intelligence quotient against duration of arrest showed a significant decrease in intelligence quotient with increasing arrest time (slope = -0.36; p = 0.002; 95% confidence interval, -0.59, -0.14) indicating a decrease of 3 to 4 intelligence quotient points for each extra 10 minutes of arrest time. It appears that deep hypothermia with circulatory arrest for cardiac operations in children does not fully protect the brain, with a linear relationship existing between the amount of impairment and the duration of circulatory arrest.

Eighty one children, comprising 51 with tetralogy of Fallot and 30 children with transposition of the great arteries (TGA) were assessed using the Wechsler intelligence scale for children -revised, and a battery of neuropsychological measures. They were compared with a group of 33 children who had surgery for ventricular septal defect. All children were aged over 10 years when reviewed and were in good health, attending normal schools. No significant negative correlation was found between any component or subtest of the IQ scores and operating age. There was no evidence of a detrimental effect of older age at operation in the children who had cyanotic heart disease as assessed by neuropsychological measures. Delaying surgery for children with TGA or tetralogy of Fallot does not appear to adversely affect their intellectual development. This finding may provide reassurance in cases where surgery has to be delayed for medical, social, or economic reasons. (Arch Dis Child 1995; 72: 298-301)

To determine if parents whose children had undergone successful cardiac surgery perceived their children any differently from parents of children who had not undergone surgery, we used the Achenbach Child Behaviour Checklist (CBCL) to compare parent and teacher perceptions in these two groups. Subjects included 168 children who had undergone cardiac surgery 4 to 8 years previously and 51 controls. On the behaviour scale of the CBCL, the teacher's mean t scores showed no significant difference between the cardiac and control groups, in contrast to the parents' scores where parents perceived a higher degree of behavioural problems in children who had undergone cardiac surgery. On the social competence scale of the CBCL, the parents scored their children who had undergone cardiac surgery as less socially competent than did the parents of the controls. Teachers' scores showed no difference between groups.

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