Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2002 Dec;87(6):506–510. doi: 10.1136/adc.87.6.506

Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries

H Hovels-Gurich 1, K Konrad 1, M Wiesner 1, R Minkenberg 1, B Herpertz-Dahlmann 1, B Messmer 1, G von Bernuth 1
PMCID: PMC1755850  PMID: 12456550

Abstract

Aims: To evaluate behavioural outcome and quality of life in children aged 8–14 years after neonatal arterial switch operation for transposition of the great arteries.

Methods: Sixty children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9–14.3 years by the Child Behaviour Checklist (CBCL) and the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL).

Results: Parent reported behavioural outcome on all CBCL problem and competence scores was worse, whereas quality of life on self reported IQCL scores was not reduced compared to the normal population. On multivariate analysis, severe preoperative hypoxia was related to parent reported social problems; peri- and postoperative cardiocirculatory insufficiency was associated with internalising, externalising, attention, and total behavioural problems. Reduced expressive language was associated with total behavioural problems, and poor academic achievement was related to parent reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self reported stress by illness.

Conclusions: The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life. This discrepancy may be a result of different perception of illness. In our experience, increased risk of long term psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.

Full Text

The Full Text of this article is available as a PDF (141.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aldén B., Gilljam T., Gillberg C. Long-term psychological outcome of children after surgery for transposition of the great arteries. Acta Paediatr. 1998 Apr;87(4):405–410. doi: 10.1080/08035259850156995. [DOI] [PubMed] [Google Scholar]
  2. Beitchman J. H., Wilson B., Johnson C. J., Atkinson L., Young A., Adlaf E., Escobar M., Douglas L. Fourteen-year follow-up of speech/language-impaired and control children: psychiatric outcome. J Am Acad Child Adolesc Psychiatry. 2001 Jan;40(1):75–82. doi: 10.1097/00004583-200101000-00019. [DOI] [PubMed] [Google Scholar]
  3. Bellinger D. C., Jonas R. A., Rappaport L. A., Wypij D., Wernovsky G., Kuban K. C., Barnes P. D., Holmes G. L., Hickey P. R., Strand R. D. Developmental and neurologic status of children after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. N Engl J Med. 1995 Mar 2;332(9):549–555. doi: 10.1056/NEJM199503023320901. [DOI] [PubMed] [Google Scholar]
  4. Bellinger D. C., Wypij D., Kuban K. C., Rappaport L. A., Hickey P. R., Wernovsky G., Jonas R. A., Newburger J. W. Developmental and neurological status of children at 4 years of age after heart surgery with hypothermic circulatory arrest or low-flow cardiopulmonary bypass. Circulation. 1999 Aug 3;100(5):526–532. doi: 10.1161/01.cir.100.5.526. [DOI] [PubMed] [Google Scholar]
  5. Cadman D., Boyle M., Szatmari P., Offord D. R. Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study. Pediatrics. 1987 May;79(5):805–813. [PubMed] [Google Scholar]
  6. Cumming G. R., Everatt D., Hastman L. Bruce treadmill test in children: normal values in a clinic population. Am J Cardiol. 1978 Jan;41(1):69–75. doi: 10.1016/0002-9149(78)90134-0. [DOI] [PubMed] [Google Scholar]
  7. DeLeon S. Y., Thomas C., Roughneen P. T., King N., Lehne R., DeLeon A. M., Walenga J., Pifarré R. Experimental evidence of cerebral injury from profound hypothermia during cardiopulmonary bypass. Pediatr Cardiol. 1998 Sep-Oct;19(5):398–403. doi: 10.1007/s002469900335. [DOI] [PubMed] [Google Scholar]
  8. DeMaso D. R., Beardslee W. R., Silbert A. R., Fyler D. C. Psychological functioning in children with cyanotic heart defects. J Dev Behav Pediatr. 1990 Dec;11(6):289–294. [PubMed] [Google Scholar]
  9. DeMaso D. R., Campis L. K., Wypij D., Bertram S., Lipshitz M., Freed M. The impact of maternal perceptions and medical severity on the adjustment of children with congenital heart disease. J Pediatr Psychol. 1991 Apr;16(2):137–149. doi: 10.1093/jpepsy/16.2.137. [DOI] [PubMed] [Google Scholar]
  10. Ellerbeck K. A., Smith M. L., Holden E. W., McMenamin S. C., Badawi M. A., Brenner J. I., Kan J. S., Hyman S. L. Neurodevelopmental outcomes in children surviving d-transposition of the great arteries. J Dev Behav Pediatr. 1998 Oct;19(5):335–341. doi: 10.1097/00004703-199810000-00003. [DOI] [PubMed] [Google Scholar]
  11. Goldmuntz E., Clark B. J., Mitchell L. E., Jawad A. F., Cuneo B. F., Reed L., McDonald-McGinn D., Chien P., Feuer J., Zackai E. H. Frequency of 22q11 deletions in patients with conotruncal defects. J Am Coll Cardiol. 1998 Aug;32(2):492–498. doi: 10.1016/s0735-1097(98)00259-9. [DOI] [PubMed] [Google Scholar]
  12. Hesz N., Clark E. B. Cognitive development in transposition of the great vessels. Arch Dis Child. 1988 Feb;63(2):198–200. doi: 10.1136/adc.63.2.198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hövels-Gürich H. H., Seghaye M. C., Däbritz S., Messmer B. J., von Bernuth G. Cardiological and general health status in preschool- and school-age children after neonatal arterial switch operation. Eur J Cardiothorac Surg. 1997 Oct;12(4):593–601. doi: 10.1016/s1010-7940(97)00232-7. [DOI] [PubMed] [Google Scholar]
  14. Hövels-Gürich H. H., Seghaye M. C., Däbritz S., Messmer B. J., von Bernuth G. Cognitive and motor development in preschool and school-aged children after neonatal arterial switch operation. J Thorac Cardiovasc Surg. 1997 Oct;114(4):578–585. doi: 10.1016/S0022-5223(97)70047-3. [DOI] [PubMed] [Google Scholar]
  15. Hövels-Gürich H. H., Seghaye M. C., Sigler M., Kotlarek F., Bartl A., Neuser J., Minkenberg R., Messmer B. J., von Bernuth G. Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation. Ann Thorac Surg. 2001 Mar;71(3):881–888. doi: 10.1016/s0003-4975(00)02515-7. [DOI] [PubMed] [Google Scholar]
  16. Hövels-Gürich Hedwig H., Seghaye Marie-Christine, Schnitker Ralph, Wiesner Magdalene, Huber Walter, Minkenberg Ralf, Kotlarek Franz, Messmer Bruno J., Von Bernuth Götz. Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation. J Thorac Cardiovasc Surg. 2002 Sep;124(3):448–458. doi: 10.1067/mtc.2002.122307. [DOI] [PubMed] [Google Scholar]
  17. Kramer H. H., Awiszus D., Sterzel U., van Halteren A., Classen R. Development of personality and intelligence in children with congenital heart disease. J Child Psychol Psychiatry. 1989 Mar;30(2):299–308. doi: 10.1111/j.1469-7610.1989.tb00242.x. [DOI] [PubMed] [Google Scholar]
  18. Kurth C. D., Priestley M., Golden J., McCann J., Raghupathi R. Regional patterns of neuronal death after deep hypothermic circulatory arrest in newborn pigs. J Thorac Cardiovasc Surg. 1999 Dec;118(6):1068–1077. doi: 10.1016/S0022-5223(99)70103-0. [DOI] [PubMed] [Google Scholar]
  19. Massin M., Hövels-Gürich H., Däbritz S., Messmer B., von Bernuth G. Results of the Bruce treadmill test in children after arterial switch operation for simple transposition of the great arteries. Am J Cardiol. 1998 Jan 1;81(1):56–60. doi: 10.1016/s0002-9149(97)00863-1. [DOI] [PubMed] [Google Scholar]
  20. Mattejat F., Jungmann J., Meusers M., Moik C., Nölkel P., Schaff C., Scholz M., Schmidt M. H., Remschmidt H. Das Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen (ILK)--Eine Pilotstudie. Z Kinder Jugendpsychiatr Psychother. 1998 Aug;26(3):174–182. [PubMed] [Google Scholar]
  21. McCormick M. C., Athreya B. H., Bernbaum J. C., Charney E. B. Preliminary observations on maternal rating of health of children: data from three subspecialty clinics. J Clin Epidemiol. 1988;41(4):323–329. doi: 10.1016/0895-4356(88)90139-4. [DOI] [PubMed] [Google Scholar]
  22. Robbins J., Klee T. Clinical assessment of oropharyngeal motor development in young children. J Speech Hear Disord. 1987 Aug;52(3):271–277. doi: 10.1044/jshd.5203.271. [DOI] [PubMed] [Google Scholar]
  23. Sigler M., Vazquez-Jimenez J. F., Grabitz R. G., Hövels-Gürich H. H., Messmer B. J., von Bernuth G., Seghaye M. C. Time course of cranial ultrasound abnormalities after arterial switch operation in neonates. Ann Thorac Surg. 2001 Mar;71(3):877–880. doi: 10.1016/s0003-4975(00)02329-8. [DOI] [PubMed] [Google Scholar]
  24. Spurkland I., Bjørnstad P. G., Lindberg H., Seem E. Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect. Acta Paediatr. 1993 Jan;82(1):71–76. doi: 10.1111/j.1651-2227.1993.tb12520.x. [DOI] [PubMed] [Google Scholar]
  25. Utens E. M., Verhulst F. C., Duivenvoorden H. J., Meijboom F. J., Erdman R. A., Hess J. Prediction of behavioural and emotional problems in children and adolescents with operated congenital heart disease. Eur Heart J. 1998 May;19(5):801–807. doi: 10.1053/euhj.1997.0855. [DOI] [PubMed] [Google Scholar]
  26. Utens E. M., Verhulst F. C., Meijboom F. J., Duivenvoorden H. J., Erdman R. A., Bos E., Roelandt J. T., Hess J. Behavioural and emotional problems in children and adolescents with congenital heart disease. Psychol Med. 1993 May;23(2):415–424. doi: 10.1017/s0033291700028518. [DOI] [PubMed] [Google Scholar]
  27. Van Horn M., DeMaso D. R., Gonzalez-Heydrich J., Erickson J. D. Illness-related concerns of mothers of children with congenital heart disease. J Am Acad Child Adolesc Psychiatry. 2001 Jul;40(7):847–854. doi: 10.1097/00004583-200107000-00020. [DOI] [PubMed] [Google Scholar]
  28. Wernovsky G., Mayer J. E., Jr, Jonas R. A., Hanley F. L., Blackstone E. H., Kirklin J. W., Castañeda A. R. Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg. 1995 Feb;109(2):289–302. doi: 10.1016/S0022-5223(95)70391-8. [DOI] [PubMed] [Google Scholar]
  29. du Plessis A. J. Mechanisms of brain injury during infant cardiac surgery. Semin Pediatr Neurol. 1999 Mar;6(1):32–47. doi: 10.1016/s1071-9091(99)80045-x. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Web-only Tables]
archdisch_87_6_506__index.html (1.4KB, html)
archdisch_archdischild;87_6_506__1.pdf (105.4KB, pdf)
archdisch_archdischild;87_6_506__2.pdf (89.1KB, pdf)
archdisch_archdischild;87_6_506__3.pdf (144.8KB, pdf)

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES