Neurodevelopmental Problems Post d-TGA Repair

Neurodevelopmental problems post d-TGA repair

Children who would never have survived to adulthood due to D-transposition of great arteries are now able to grow well into adulthood, thanks to neonatal arterial switch operation. Survival has unmasked a few neurodevelopmental problems in this group. Boston circulatory arrest study was a randomized trial comparing outcomes between those who underwent arterial switch operation in early infancy with either total circulatory arrest and deep hypothermia or continuous low flow cardiopulmonary bypass. A study found that though the two groups were similar in their performance, there was significant difference when compared to the general population. The study by David C Bellinger, David Wypij, Michael J Rivkin, David R DeMaso, Richard L Robertson Jr, Carolyn Dunbar-Masterson, Leonard A Rappaport, Gil Wernovsky, Richard A Jonas and Jane W Newburger [1] showed that seizures in the postoperative period was the most important factor associated with worse outcome in terms of neurodevelopmental risk. Around hundred and forty adolescents participated in this study. The parameters evaluated were: academic achievement, memory, executive functions, visual-spatial skills, attention, and social cognition. About two third of them had received remedial training for behavioural or academic needs. One third of them had abnormalities on magnetic resonance imaging of the brain in the form of mineralization or iron deposits, more often focal than diffuse. It was found that longer time on cardiopulmonary bypass and more exposure to cardiac catheterization were were independent risk factors for brain mineralization. Authors suggested that children who have undergone D-TGA repair should be followed up for early detection and management of neurocognitive and behavioural problems.

Reference

  1. David C Bellinger, David Wypij, Michael J Rivkin, David R DeMaso, Richard L Robertson Jr, Carolyn Dunbar-Masterson, Leonard A Rappaport, Gil Wernovsky, Richard A Jonas, Jane W Newburger. Adolescents With d-Transposition of the Great Arteries Corrected With the Arterial Switch Procedure. Neuropsychological Assessment and Structural Brain Imaging. Circulation. 2011; 124: 1361-1369