Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: Neurodevelopmental outcome

Karl, Tom R.; Hall, Suzanne; Ford, Geoff; Kelly, Elaine; Brizard, Christian P.; Mee, Roger B.B.; Weintraub, Robert G.; Cochrane, Andrew; Glidden, David V.

doi:10.1016/j.jtcvs.2003.06.001

Cited by 118 publications

(66 citation statements)

References 22 publications

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“…Our findings are concordant with previous publications demonstrating a high lifetime prevalence of ADHD, with inattention and hyperactivity, in children with congenital heart disease. 24-26 Given the high rates of ADHD associated with d-TGA, 27-29 the effectiveness of stimulants in ADHD, 30,31 and the reported tolerability of these medications in youth with complex heart disease, 28 primary care clinicians and cardiologists should consider psychotropic medication as a treatment option.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric Disorders and Function in Adolescents with d-Transposition of the Great Arteries

DeMaso

Labella

Taylor

et al. 2014

The Journal of Pediatrics

105

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Objective To compared adolescents with with d-transposition of the great arteries (d-TGA) with healthy adolescents with respect to prevalence of psychiatric disorders and global psychosocial functioning. Study design Subjects, consisting of 139 adolescents with d-TGA (16.1±0.5 years) and 61 healthy adolescents (15.3±1.1 years) without known risk factors for brain disorders, underwent a battery of assessments, including semi-structured psychiatric interviews; self-report measures of depressive, anxiety, and disruptive behavior symptoms; and brain magnetic resonance imaging. Previous cognitive functioning and parental stress assessments at age eight as well as parental post-traumatic stress at age 16 years were explored as potential risk factors predictive of overall psychiatric functioning. Results Compared with healthy adolescents, adolescents with d-TGA had higher lifetime prevalence of structured interview-derived ADHD (19% versus 7%, P=0.03), along with reduced global psychosocial functioning (80.6±11.2 versus 87.2±7.1, P<0.001) as well as significant increases in self-reported depressive (P=0.01), anxiety (P=0.02), and disruptive behavior symptoms (parent P<0.001 and adolescent P=0.03). Nevertheless, these youth scored in the non-clinical range on all self-report measures. Level of global psychosocial functioning was positively related to cognitive functioning (P<0.001) and negatively related to parental stress (P=0.008). Conclusions Although adolescents with d-TGA demonstrate significant resilience to known neuropsychological and academic deficits, they show increased rates of ADHD and reduced psychosocial functioning. Impaired cognitive functioning and parental stress at younger age emerged as significant risk factors for psychiatric impairment.

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Section: Discussionmentioning

confidence: 99%

Psychiatric Disorders and Function in Adolescents with d-Transposition of the Great Arteries

DeMaso

Labella

Taylor

et al. 2014

The Journal of Pediatrics

105

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“…65 A variety of pre- and post-operative factors are thought to increase the risk of these problems including the type of cardiac lesion, 66 preoperative hypoxia, 64 low pH, 67 age at surgery, 65 palliative versus corrective operative procedure, 62 deep hypothermic cardiac arrest, 68 and length of cardiac intensive care unit stay. 65 …”

Section: Introductionmentioning

confidence: 99%

Stroke in Children With Cardiac Disease: Report From the International Pediatric Stroke Study Group Symposium

Sinclair

Fox

Ichord

et al. 2015

Pediatric Neurology

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BACKGROUND Cardiac disease is a leading cause of stroke in children, yet limited data support the current stroke prevention and treatment recommendations. A multidisciplinary panel of clinicians was convened in February 2014 by the International Pediatric Stroke Study group to identify knowledge gaps and prioritize clinical research efforts for children with cardiac disease and stroke. RESULTS Significant knowledge gaps exist, including a lack of data on stroke incidence, predictors, primary and secondary stroke prevention, hyperacute treatment, and outcome in children with cardiac disease. Commonly used diagnostic techniques including brain computed tomography and ultrasound have low rates of stroke detection, and diagnosis is frequently delayed. The challenges of research studies in this population include epidemiologic barriers to research such as small patient numbers, heterogeneity of cardiac disease, and coexistence of multiple risk factors. Based on stroke burden and study feasibility, studies involving mechanical circulatory support, single ventricle patients, early stroke detection strategies, and understanding secondary stroke risk factors and prevention are the highest research priorities over the next 5-10 years. The development of large-scale multicenter and multispecialty collaborative research is a critical next step. The designation of centers of expertise will assist in clinical care and research. CONCLUSIONS There is an urgent need for additional research to improve the quality of evidence in guideline recommendations for cardiogenic stroke in children. Although significant barriers to clinical research exist, multicenter and multispecialty collaboration is an important step toward advancing clinical care and research for children with cardiac disease and stroke.

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“…Hövels-Gürich et al (42) and Karl et al (19) showed an increased risk of parent-reported psychosocial maladjustment in children and adolescents with d -TGA. In the BCAS, 16-year-olds with d -TGA were more likely than controls (35 versus 20%) to meet criteria for a lifetime psychiatric diagnosis, as evaluated by the Schedule for Affective Disorders and Schizophrenia for School-aged Children (K-SADS) (45).…”

Section: Adolescents With D-tga: Cognitive and Psychiatric Outcomesmentioning

confidence: 97%

“…Nevertheless, deficits are often apparent in specific neurocognitive areas. Speech and motor impairments were reported in both European (17, 18) and North-American studies (13, 19). Bellinger et al (12, 13) reported below age-expected scores for 4- and 8-year-old children in visual–spatial skills, academic achievement, working memory, hypothesis generation, sustained attention, and higher order language skills.…”

Section: Neuropsychological Outcomes In Children With D-tgamentioning

confidence: 99%

Neuropsychological and Psychiatric Outcomes in Dextro-Transposition of the Great Arteries across the Lifespan: A State-of-the-Art Review

et al. 2017

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Advances in prenatal diagnosis, perioperative management, and postoperative care have dramatically increased the population of survivors of neonatal and infant heart surgery. The high survival rate of these patients into adulthood has exposed the alarming prevalence of long-term neuropsychological and psychiatric morbidities. Dextro-transposition of the great arteries (d-TGA) is one of the most extensively studied cyanotic congenital heart defect (CHD) with regard to neurodevelopmental outcomes. Landmark studies have described a common neurodevelopmental and behavioral phenotype associated with d-TGA. Children with d-TGA display impairments in key neurocognitive areas, including visual–spatial and fine motor abilities, executive functioning, processing speed, and social cognition. As they grow older, they may face additional challenges with a worsening of deficits in higher order cognitive skills, problems in psychosocial adjustment and a higher-than-expected rate of psychiatric disorders, such as attention-deficit hyperactivity disorder, depression, and anxiety. The aim of this review is to summarize the available recent data on neuropsychological and psychiatric outcomes in individuals with d-TGA after the arterial switch operation. We present findings within a life-span perspective, with a particular emphasis on the emerging literature on adolescent and young adult outcomes. Finally, we propose avenues for future research in the CHD adult neuropsychology field. Among these avenues, we explore the potential mechanisms by which pediatric neurodevelopmental impairments may have lifelong adverse effects as well as alternative interventions that could optimize outcomes.

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Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: Neurodevelopmental outcome

Cited by 118 publications

References 22 publications

Psychiatric Disorders and Function in Adolescents with d-Transposition of the Great Arteries

Psychiatric Disorders and Function in Adolescents with d-Transposition of the Great Arteries

Stroke in Children With Cardiac Disease: Report From the International Pediatric Stroke Study Group Symposium

Neuropsychological and Psychiatric Outcomes in Dextro-Transposition of the Great Arteries across the Lifespan: A State-of-the-Art Review

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