HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bruno J. Messmer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hövels-Gürich, H. H. Articles by Seghaye, M.-C. Search for Related Content PubMed PubMed Citation Articles by Hövels-Gürich, H. H. Articles by Seghaye, M.-C. Related Collections Congenital - cyanotic

Ann Thorac Surg 2007;83:1425-1430
© 2007 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Attentional Dysfunction in Children After Corrective Cardiac Surgery in Infancy

^a Department of Pediatric Cardiology, Aachen University of Technology, Aachen, Germany
^b Department of Child and Adolescent Psychiatry, Aachen University of Technology, Aachen, Germany
^c Department of Thoracic and Cardiovascular Surgery, Aachen University of Technology, Aachen, Germany

Accepted for publication October 26, 2006.

^_* Address correspondence to Dr Hövels-Gürich, Department of Pediatric Cardiology, University Hospital, Aachen University of Technology, Pauwelsstr 30, Aachen D-52057, Germany (Email: hhoevels-guerich{at}ukaachen.de).

Background: Attentional dysfunction in children after corrective cardiac surgery in infancy has rarely been evaluated and is the topic of the present work.

Methods: Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on at a mean age 0.7 (SD 0.3) years with deep hypothermic circulatory arrest and low flow cardiopulmonary bypass, were evaluated at mean age 7.4 (SD 1.6) years by the computerized form of the Attention Network Test providing performance measures of three networks of attention: alerting, orienting, and executive control. Parental ratings of attentional dysfunction were derived from the Child Behavior Checklist. Results were compared with healthy controls, between patient groups, and correlated with perioperative risk factors and current neurodevelopmental status.

Results: Executive control was reduced in the tetralogy of Fallot group, alerting and orienting were found normal and not different between patient groups. Durations of aortic cross clamping inversely correlated with orienting; durations of cardiopulmonary bypass correlated with mean reaction time and inversely correlated with executive control. Motor function and acquired abilities correlated with executive control and orienting. Parent-reported problems on the Child Behavior Checklist inversely correlated with executive control and mean accuracy.

Conclusions: Children with preoperative hypoxemia in infancy due to cyanotic cardiac defects are at increased risk for attentional dysfunction in the field of executive control, compared with normal children and with those who have acyanotic heart defects. Besides unfavorable perioperative influences, preoperative hypoxemia is considered responsible for additional damage to the highly oxygen sensitive regions of the prefrontal cortex and striate body assumed to be associated with the executive control network of attention.

This article has been cited by other articles:

				J. W. Gaynor, A. S. Nord, G. Wernovsky, J. Bernbaum, C. B. Solot, N. Burnham, E. Zackai, P. J. Heagerty, R. R. Clancy, S. C. Nicolson, et al. Apolipoprotein E Genotype Modifies the Risk of Behavior Problems After Infant Cardiac Surgery Pediatrics, July 1, 2009; 124(1): 241 - 250. [Abstract] [Full Text] [PDF]

				D. J. Licht, D. M. Shera, R. R. Clancy, G. Wernovsky, L. M. Montenegro, S. C. Nicolson, R. A. Zimmerman, T. L. Spray, J. W. Gaynor, and A. Vossough Brain maturation is delayed in infants with complex congenital heart defects. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 529 - 536. [Abstract] [Full Text] [PDF]

				R. van der Rijken, G. Hulstijn-Dirkmaat, F. Kraaimaat, L. Nabuurs-Kohrman, A. Nijveld, B. Maassen, and O. Daniels Open-heart surgery at school age does not affect neurocognitive functioning Eur. Heart J., November 1, 2008; 29(21): 2681 - 2688. [Abstract] [Full Text] [PDF]

				M. Redlin, A. Koster, M. Huebler, W. Boettcher, N. Nagdyman, R. Hetzer, H. Kuppe, and W. M. Kuebler Regional differences in tissue oxygenation during cardiopulmonary bypass for correction of congenital heart disease in neonates and small infants: relevance of near-infrared spectroscopy. J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 962 - 967. [Abstract] [Full Text] [PDF]

				A. J. Shillingford, M. M. Glanzman, R. F. Ittenbach, R. R. Clancy, J. W. Gaynor, and G. Wernovsky Inattention, Hyperactivity, and School Performance in a Population of School-Age Children With Complex Congenital Heart Disease Pediatrics, April 1, 2008; 121(4): e759 - e767. [Abstract] [Full Text] [PDF]

				G. Wernovsky Improving neurologic and quality-of-life outcomes in children with congenital heart disease: Past, present, and future J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 240 - 242. [Full Text] [PDF]