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Effects of cardiac surgery on intellectual function in infants and children
1Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.
Insights
Cardiac surgery in children generally does not impair intellectual function. However, prolonged hypothermic total circulatory arrest exceeding 50 minutes may lead to decreased developmental quotients (DQ).
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Pediatric Cardiac Surgery
Background:
- Congenital heart defects necessitate surgical intervention in infants and children.
- Assessing the impact of cardiac surgery on cognitive development is crucial for long-term patient outcomes.
Purpose of the Study:
- To evaluate the effect of cardiac surgery on intellectual function in pediatric patients.
- To identify potential risk factors for neurodevelopmental impairment following cardiac procedures.
Main Methods:
- Intellectual function assessed using Gesell's developmental quotient (DQ) and Binet's intelligence quotient (IQ) in 161 children pre- and post-surgery.
- Patients categorized by specific heart defects and surgical approach, including those with and without circulatory arrest.
Main Results:
- No significant preoperative differences in DQ or IQ observed among patient groups.
- Children undergoing total circulatory arrest for over 50 minutes showed a significant decrease in DQ scores.
- Patients without circulatory arrest or those with shunt procedures exhibited no significant postoperative impairment in DQ or IQ.
Conclusions:
- Cardiac surgery is not associated with impaired intellectual function in pediatric patients.
- Prolonged hypothermic total circulatory arrest (>50 minutes) poses a risk for cerebral dysfunction and reduced intellectual function.
Abstract:
Intellectual function was evaluated by Gesell's developmental quotient (DQ) and Binet's intelligence quotient (IQ) in 161 infants and children (61 ventricular septal defects, 49 tetralogies of Fallot, 15 transpositions of the great arteries, seven atrial septal defects, five complete atrioventricular canals, five double outlet right ventricles and 19 shunt cases; average age 3.6 years) before and after cardiac surgery. There were no significant differences in preoperative DQs and IQs among the patient groups. Although average DQ scores in 21 infants with hypothermic (13-24 degrees C) total circulatory arrest (36-70 min) were not significantly different from the preoperative values, 13 patients with an arrest time > 50 min showed a significant decrease in DQ scores. The postoperative DQ and IQ scores in patients without circulatory arrest or in shunt cases were not significantly impaired after surgery. It was concluded that cardiac surgery did not impair intellectual function in infants and children, although cerebral dysfunction might occur if circulatory arrest was > 50 min.