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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
Summary
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.