RESUMEN
Psychomotor problems are common in children with congenital heart disease (CHD) but their neuropsychological basis remains unknown. This study investigated motor planning, motor control, and motor slowness, three subprocesses potentially underlying these psychomotor deficits. Using various drawing tasks, 45 school-age children with CHD were compared with 41 healthy peers on several kinematic properties. Taking longer to initiate and execute their movements than the controls, the children with CHD exhibited significant motor slowness. No evidence was found for deficits in planning or motor control. Thus, motor slowness appears to be the major determinant of psychomotor problems in school-age children with CHD.
Asunto(s)
Cardiopatías Congénitas/complicaciones , Trastornos de la Destreza Motora/etiología , Desempeño Psicomotor/fisiología , Adolescente , Análisis de Varianza , Niño , Trastornos del Conocimiento/etiología , Femenino , Escritura Manual , Humanos , Masculino , Pruebas Neuropsicológicas , Tiempo de ReacciónRESUMEN
AIM: Children with congenital heart disease (CHD) are at risk of developing neurocognitive problems. However, as these problems are usually identified after cardiac surgery, it is unclear whether they resulted from the surgery or whether they pre-existed and hence might be explained by complications and events associated with the heart disease itself. The purpose of this study was to examine whether neurocognitive deficits commonly reported after cardiac surgery are present before surgery. METHOD: Forty-five children (22 males, 23 females; mean age 11 y 6 mo, SD 3 y 0 mo) with cyanotic and acyanotic heart diseases scheduled for elective cardiac surgery were compared with 41 healthy peers (17 males, 24 females; mean age 11 y 10 mo, SD 2 y 10 mo) for attention and processing speed, construction, motor speed, motor planning and fluency, and visual memory. Twenty-three children in the patient group were awaiting their first cardiac surgery and 22 were awaiting follow-up surgery. RESULTS: The patients showed manifest neurocognitive difficulties. Their performance was inferior to that of the healthy comparison group for motor planning (p=0.02) and visual memory (p=0.01). The same neurocognitive profile was found in the group of patients awaiting their first cardiac operation. INTERPRETATION: School-age children with various forms of CHD are at risk of neurocognitive impairments before cardiac surgery.
Asunto(s)
Trastornos del Conocimiento/complicaciones , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/cirugía , Adolescente , Análisis de Varianza , Niño , Procedimientos Quirúrgicos Electivos , Femenino , Cardiopatías Congénitas/diagnóstico , Humanos , Masculino , Análisis Multivariante , Pruebas Neuropsicológicas , Factores de TiempoRESUMEN
AIMS: Although neurocognitive problems after open-heart surgery for congenital heart disease are frequent, due to a shortage of prospective studies assessing neurocognitive functioning both before and after the procedure, the exact nature of the deficits usually remains unknown. The present study aims at assessing the neurocognitive effects of, in particular, cardiopulmonary bypass at school age. In addition, surgery-related risk factors for reduced neurocognitive outcome are explored. METHODS AND RESULTS: Participants were aged between 6 and 16 years. Forty-three children indicated for open-heart surgery and a comparison group of 19 children scheduled for interventional cardiac catheterization completed a neurocognitive assessment battery before and 1 year after their procedures. Forty healthy matched controls did so at a 1 year interval. The baseline-to-follow-up outcomes were similar in all three groups. The observed improvements most likely resulted from increased age and the repeated neurocognitive assessment. No risk factors for postsurgical neurocognitive deficits were identified. CONCLUSION: The present study demonstrates that at school age cardiac surgery using full-flow cardiopulmonary bypass does not affect neurocognitive functioning.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Trastornos del Conocimiento/etiología , Cardiopatías Congénitas/cirugía , Adolescente , Cateterismo Cardíaco , Puente Cardiopulmonar/psicología , Niño , Cognición/fisiología , Trastornos del Conocimiento/psicología , Métodos Epidemiológicos , Femenino , Cardiopatías Congénitas/psicología , Humanos , Masculino , Pruebas NeuropsicológicasRESUMEN
OBJECTIVES: To explore the long-term physical, educational, behavioural, and emotional outcome of patients undergoing surgical correction of congenital cardiac disease at school age, and to investigate the relation, if any, between the outcome and comorbidity, age and sex, and level of complexity of the cardiac surgery. METHODS: Information was obtained concerning 101 patients who underwent open-heart surgery for correction of congenital cardiac malformations between 1992 and 2000 whilst aged from 6 to 16 years. The patients, and their parents, completed the questionnaire "Outcome of congenital heart disease and surgery", the RAND 36-Item Health Survey, and the Child Behaviour Checklist/Youth Self-Report/Young Adult Self-Report. RESULTS: Of the patients, 26% had comorbidity. Of those without comorbidity, 39% had frequent physical complaints, and 28% experienced limitations due to the cardiac disease. Nevertheless, the patients reported a good subjective state of health, and did not report any behavioural or emotional problems. Patients did show academic difficulties. They had received special education more frequently than their healthy peers, and many had needed to repeat a grade, or had received remedial teaching. Consequently, the educational level of patients was lower than that of their healthy peers. Patients with comorbidity, female patients, and patients who underwent complex surgery, seemed to be most at risk for physical, behavioural, and emotional problems. CONCLUSION: It is necessary to distinguish between physical state and its appraisal, and clinicians should be aware of this. Further research is needed to find out the cause and nature of the academic difficulties. Groups of patients at risk should be followed closely to enable early interventions.