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Published on: September 18, 2012
Visual-spatial skills in children after open-heart surgery
David C Bellinger1, Jane H Bernstein, Michael W Kirkwood
1Department of Neurology, CHildren's Hospital, Harvard Medical School, Boston, MA 02115, USA. david.bellinger@tch.harvard.edu
Insights
Visual-spatial deficits are common in children after infant heart surgery, often linked to visual-perceptual issues rather than surgical methods. These deficits impact math skills and educational support needs.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Outcomes
- Pediatric Cardiac Surgery
Background:
- Infant cardiac surgery requires vital organ support, with total circulatory arrest and low-flow cardiopulmonary bypass being common methods.
- Long-term neurodevelopmental effects, particularly visual-spatial deficits, following such surgeries require further investigation.
- Understanding the underlying causes and consequences of these deficits is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate visual-spatial deficits in 8-year-old children after arterial switch operation for D-transposition of the great arteries.
- To determine associations between deficits and surgical/perioperative variables.
- To identify whether deficits stem from visual-perceptual, motor control, or metacognitive impairments and their link to adaptive difficulties.
Main Methods:
- A cohort of 155 children who underwent arterial switch operation before 3 months of age were assessed at 8 years old.
- The Rey-Osterrieth Complex Figure (ROCF) was used to evaluate visual-spatial skills, with copy productions scored for organization level.
- Logistic regression models analyzed relationships between ROCF scores, surgical variables, cognitive functions, and adaptive outcomes.
Main Results:
- Over half (52%) of the children exhibited low visual-spatial organization (ROCF Level 1), exceeding expected rates.
- Low ROCF scores were not linked to specific organ support methods or surgical variables.
- Poor visual-perceptual abilities were stronger predictors of low ROCF scores than motor control or metacognitive deficits.
Conclusions:
- Visual-spatial deficits are prevalent in children post-infant heart surgery and primarily reflect visual-perceptual impairments.
- These deficits do not appear to be directly associated with the intraoperative organ support methods or postoperative events studied.
- Children with poorer visual-spatial skills showed lower mathematics scores and a higher likelihood of receiving remedial education services.
Abstract:
This study was part of a randomized clinical trial comparing the central nervous system effects of the two vital organ-support methods used in infant cardiac surgery: total circulatory arrest and low-flow cardiopulmonary bypass. The extent to which visual-spatial deficits are (1). associated with surgical and perioperative variables, (2). attributable to visual-perceptual, motor control, or metacognitive deficits, and (3). associated with adaptive difficulties at home or school was evaluated. The subjects were 155 8-year-old children with D-transposition of the great arteries who underwent the arterial switch operation before 3 months of age. As part of a comprehensive evaluation, the Rey-Osterrieth Complex Figure (ROCF) was administered. ROCF copy productions were classified as having a Basal Organization Level of 1 (low) or 2 or greater. A five-category clinical rating was also assigned. More than half of the children in the cohort (52%) had copy productions scored at Level 1, more than twice the expected frequency. The risk of having a low score was not associated with vital organ support method or other surgical variables. On the basis of comparisons of the relative fits of nested logistic regression models, poor visual-perceptual abilities were more predictive of having a Level 1 score than either motor control or metacognitive deficits. Children with poor copy production scores had lower mathematics scores, but not lower reading scores or poorer parent and teacher ratings of adaptive competence. The percentage of children receiving remedial school services was associated with ROCF clinical rating, ranging from 58% in the worst category to 8% in the best category. Visual-spatial deficits are common among children after infant heart surgery and seem to reflect visual-perceptual rather than motor control or metacognitive deficits. In addition, these deficits do not seem to be clearly associated with the intraoperative methods or postoperative events evaluated.
