Original article
Cardiovascular
Attentional Dysfunction in Children After Corrective Cardiac Surgery in Infancy

https://doi.org/10.1016/j.athoracsur.2006.10.069Get rights and content

Background

Attentional dysfunction in children after corrective cardiac surgery in infancy has rarely been evaluated and is the topic of the present work.

Methods

Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on at a mean age 0.7 (SD 0.3) years with deep hypothermic circulatory arrest and low flow cardiopulmonary bypass, were evaluated at mean age 7.4 (SD 1.6) years by the computerized form of the Attention Network Test providing performance measures of three networks of attention: alerting, orienting, and executive control. Parental ratings of attentional dysfunction were derived from the Child Behavior Checklist. Results were compared with healthy controls, between patient groups, and correlated with perioperative risk factors and current neurodevelopmental status.

Results

Executive control was reduced in the tetralogy of Fallot group, alerting and orienting were found normal and not different between patient groups. Durations of aortic cross clamping inversely correlated with orienting; durations of cardiopulmonary bypass correlated with mean reaction time and inversely correlated with executive control. Motor function and acquired abilities correlated with executive control and orienting. Parent-reported problems on the Child Behavior Checklist inversely correlated with executive control and mean accuracy.

Conclusions

Children with preoperative hypoxemia in infancy due to cyanotic cardiac defects are at increased risk for attentional dysfunction in the field of executive control, compared with normal children and with those who have acyanotic heart defects. Besides unfavorable perioperative influences, preoperative hypoxemia is considered responsible for additional damage to the highly oxygen sensitive regions of the prefrontal cortex and striate body assumed to be associated with the executive control network of attention.

Section snippets

Patient Population

The study was approved by the Ethical Medical Committee of the Aachen University of Technology, and written informed consent of the parents was obtained.

The study group comprised a total of 40 unselected children, divided into two subgroups. Group A consisted of 20 patients with TOF (age at corrective surgery 0.7 ± 0 .3 years, age at evaluation 7.4 ± 1.4 years). Group B consisted of 20 patients with VSD (age at corrective surgery 0 .7 ± 0.2 years, age at evaluation 7.4 ± 1.9 years).

Attentional Functions Compared With Healthy Controls and Between TOF and VSD Patients

Group comparisons among the three groups (TOF, VSD, controls) including IQ as covariate revealed a significant group effect only for the conflict system whereas the two other attentional networks (alerting and orienting) as well as the mean reaction time and mean accuracy did not differ between the groups (Table 2). Pairwise analysis of covariance showed a significantly reduced conflict performance in the TOF group when compared with the control group (p = 0.005) as well as with the VSD group (p

Comment

Corrective surgical procedures for cardiac defects in infancy should carry the chance for a life that might differ less from that of healthy children compared with patients who undergo surgical intervention at a later age. On the other hand, current understanding of mid- and long-term neurology and development of the operated-on children considers multiple, mostly interrelated preoperative, perioperative, and postoperative risk factors that may adversely affect the central nervous system

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