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Neurodevelopmental outcome after early repair of a ventricular septal defect with or without aortic arch obstruction
Jonathan R Kaltman1, Gail P Jarvik, Judy Bernbaum
1Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pa 19104, USA. kaltman@email.chop.edu
Insights
Most infants undergoing surgical repair for ventricular septal defect (VSD) or VSD with aortic arch obstruction showed normal neurodevelopmental outcomes at one year. Genetic syndromes were associated with lower scores, but surgical factors did not significantly impact development.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Pediatric Cardiac Surgery
Background:
- Infant cardiac surgery survivors often exhibit neurodevelopmental disabilities.
- Limited data exist on the neurodevelopmental outcomes of infants undergoing surgical repair for ventricular septal defects (VSD).
Purpose of the Study:
- To evaluate the neurodevelopmental outcome at one year of age in children who underwent surgical repair in infancy for a VSD or VSD with aortic arch obstruction.
Main Methods:
- A cohort of infants (<6 months) undergoing VSD repair or VSD with aortic arch obstruction repair were assessed at one year using the Bayley Scales of Infant Development II.
- The study measured the Mental Development Index (MDI) and Psychomotor Development Index (PDI), with a population mean of 100 ± 15.
Main Results:
- Fifty-five patients (36 VSD alone, 19 VSD with aortic arch obstruction) were evaluated.
- The mean MDI was 92.6 ± 11.7 and the mean PDI was 86.1 ± 16.4.
- Patients with genetic syndromes had significantly lower MDI and PDI scores (P = .011 and P = .001, respectively).
- Neurodevelopmental outcomes were independent of aortic arch obstruction and deep hypothermic circulatory arrest.
Conclusions:
- The majority of infants undergoing surgical repair for VSD or VSD with aortic arch obstruction in infancy demonstrated neurodevelopmental outcomes within normal limits at one year of age.
Objectives:
Cross-sectional studies of intermediate-term survivors of infant cardiac surgery have revealed a high frequency of neurodevelopmental disabilities. Few data exist regarding neurodevelopmental outcome of infants undergoing surgical intervention for a ventricular septal defect. The purpose of this study was to evaluate the neurodevelopmental outcome at 1 year of age of children who had surgical repair in infancy of a ventricular septal defect or a ventricular septal defect with aortic arch obstruction.
Methods:
Children who underwent repair of a ventricular septal defect or single-stage repair of a ventricular septal defect with aortic arch obstruction at less than 6 months of age were assessed at 1 year of age by using the Bayley Scales of Infant Development II, which yields the Mental Development Index and the Psychomotor Development Index, both with an expected mean of 100 +/- 15.
Results:
At 1 year, 55 patients (ventricular septal defect alone = 36; ventricular septal defect with aortic arch obstruction = 19) returned for evaluation. The mean Mental Development Index was 92.6 +/- 11.7, with 3 (5%) patients scoring 70 or less. The mean Psychomotor Development Index was 86.1 +/- 16.4, with 10 (18%) patients scoring 70 or less. Patients with a suspected or confirmed genetic syndrome had both a lower Mental Development Index score (P = .011) and a lower Psychomotor Development Index score (P = .001). Mental Development Index and Psychomotor Development Index were independent of anatomic (specifically aortic arch obstruction) and intraoperative factors (specifically deep hypothermic circulatory arrest).
Conclusions:
Neurodevelopmental outcome at 1 year of age was within the normal limits for most patients who underwent repair of a ventricular septal defect or a ventricular septal defect with aortic arch obstruction during infancy.
