[en] BACKGROUND: Neurodevelopmental outcome after neonatal arterial switch operation for complete transposition of the great arteries is an important topic needing prospective assessment. METHODS: A group of 33 unselected children (3.0 to 4.6 years) operated on as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass and a control group of 32 age-matched healthy children (3.0 to 4.8 years) underwent evaluation of socioeconomic and clinical neurological status and a standardized test comprising all areas of child development. Results of patients were related to those of the control group, to population norms, and to preoperative, perioperative, and postoperative cerebral risk factors. RESULTS: Clinical neurological status was normal in 26 patients (78.8%) and reduced in 7 (21.2%). Complete developmental score and the subscores for motor function, visual perception, learning and memory, cognitive function, language, and socioemotional functions were not different compared to population norms. Compared to the patients, the children of the control group scored higher on tests of complete development, cognition, and language, but also on socioeconomic status. Complete developmental score and the scores for motor, cognitive, and language functions were weakly inversely related to the duration of circulatory arrest, but not to the duration of bypass. Cerebral risk factors such as serum levels of the neuron-specific enolase, perinatal acidosis, perinatal asphyxia, peri- and postoperative cardiocirculatory insufficiency, or clinical seizures were not correlated to the test results. CONCLUSIONS: Neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with neurological impairment, but not with reduced development as assessed by formal testing of motor, cognitive, language, and behavioral functions. Perioperative serum level of the neuron-specific enolase is not a valid marker for later developmental impairment.
Bellinger, D.C., Wernovsky, G., Rappaport, L.A., Cognitive development of children following early repair of transposition of the great arteries using deep hypothermic circulatory arrest (1991) Pediatrics, 87, pp. 701-707
Newburger, J.W., Jonas, R.A., Wernovsky, G., A comparison of the perioperative neurologic effects of hypothermic circulatory arrest versus low-flow cardiopulmonary bypass in infant heart surgery (1993) N Engl J Med, 329, pp. 1057-1064
Bellinger, D.C., Jonas, R.A., Rappaport, L.A., Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass (1995) N Engl J Med, 332, pp. 549-555
Bellinger, D.C., Wypij, D., Kuban, K.C., Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass (1999) Circulation, 100, pp. 526-532
Hövels-Gürich, H.H., Seghaye, M.C., Däbritz, S., Messmer, B.J., Von Bernuth, G., Cognitive and motor development in pre-school- and school-aged children after neonatal arterial switch operation (1997) J Thorac Cardiovasc Surg, 114, pp. 578-585
Stevenson, J., Stone, E., Dillard, D., Morgan, B., Intellectual development in children subjected to prolonged circulatory arrest during hypothermic open heart surgery in infancy (1974) Circulation, 49 (SUPPL. 2), pp. 54-59
Messmer, B.J., Schallberger, U., Gattiker, R., Senning, A., Psychomotor and intellectual development after deep hypothermia and circulatory arrest in early infancy (1976) J Thorac Cardiovasc Surg, 72, pp. 495-502
Abel, H.T., Zinsmeyer, J., Lamme, W., Gross, J., Köditz, H., Psychomotorische entwicklung von risikoneugeborenen unter berücksichtigung der konzentration der neuronenspezifischen enolase (1992) Klin Pädiatr, 204, pp. 21-26
Moore, H., Kleining, G., Das soziale selbstbild der gesellschaftsschichten in Deutschland (1968) Kölner Zeitschrift für Soziologie und Sozialpsychologie, 20, pp. 86-119
Ellerbeck, K.A., Smith, M.L., Holden, E.W., Neurodevelopmental outcomes in children surviving d-transpositon of the great arteries (1998) J Dev Behav Pediatr, 19, pp. 335-341
Fallon, P., Aparicio, J.M., Elliott, M.J., Kirkham, F.J., Incidence of neurological complications of surgery for congenital heart disease (1995) Arch Dis Child, 72, pp. 418-422
Majnemer, A., Limperopoulos, C., Rosenblatt, B., Shevell, M., Rohlicek, C., Tchervenkov, C., Neurodevelopmental status of infants with congenital heart defects prior to and following open heart surgery (1996) Ann Neurol, 40, p. 289
Holden, K.R., Sessions, J.C., Curé, J., Whitcomb, D.S., Sade, R.M., Neurologic outcomes in children with post-pump choreoathetosis (1998) J Pediatr, 132, pp. 162-164
Jonas, R.A., Neurological protection during cardiopulmonary bypass/deep hypothermia (1998) Pediatr Cardiol, 19, pp. 321-330
Kirkham, F.J., Recognition and prevention of neurological complications in pediatric cardiac surgery (1998) Pediatr Cardiol, 19, pp. 331-345
Chow, G., Roberts, I.G., Edwards, A.D., The relation between pump flow rate and pulsatility on cerebral hemodynamics during pediatric cardiopulmonary bypass (1997) J Thorac Cardiovasc Surg, 114, pp. 568-577
Jonas, R.A., Deep hypothermic circulatory arrest: A need for caution (1996) Ann Thorac Surg, 61, pp. 779-780
Jonas, R.A., Hypothermia, circulatory arrest and the pediatric brain (1996) J Cardiothorac Vasc Anaesth, 10, pp. 66-74
Du Plessis, A.J., Jonas, R.A., Wypii, P.R., Perioperative effects of alpha-stat versus pH-stat strategies for deep hypothermic cardiopulmonary bypass in infants (1997) J Thorac Cardiovasc Surg, 114, pp. 991-1001
Taylor, K.M., Central nervous system effects of cardiopulmonary bypass (1998) Ann Thorac Surg, 66, pp. S20-S24
Bellinger, D.C., Rappaport, L.A., Wypii, D., Wernovsky, G., Newburger, J.W., Patterns of developmental dysfunction after surgery during infancy to correct transpositon of the great arteries (1997) J Dev Behav Pediatr, 18, pp. 75-83
Rappaport, L.A., Wypii, D., Bellinger, D.C., Relation of seizures after cardiac surgery in early infancy to neurodevelopmental outcome (1998) Circulation, 97, pp. 773-779
Helmers, S.L., Wypii, D., Constantinou, J.E., Perioperative electroencephalographic seizures in infants undergoing repair of complex congenital cardiac defects (1997) Electroenceph Clin Neurophys, 102, pp. 27-36
Johnsson, P., Lundqvist, C., Lindgren, A., Ferencz, I., Alling, C., Stahl, E., Cerebral complications after cardiac surgery assessed by S-100 and NSE levels in blood (1995) J Cardiothorac Vasc Anaesth, 9, pp. 694-699
Johnsson, P., Markers of cerebral ischemia after cardiac surgery (1996) J Cardiothorac Vasc Anaesth, 10, pp. 120-126
Abel, H.T., Von Rohden, L., Lamme, W., Korb, C., Zinsmeyer, J., Köditz, H., Gross, J., Intrazerebrale blutungen und neuronenspezifische enolase bei früh- und termingeborenen - Eine klinische studie (1993) Pädiatr Grenzgeb, 31, pp. 133-140
