Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection
Late neurodevelopmental outcome after repair of total anomalous pulmonary venous connection
复制标题
DOI：
10.1016/j.jtcvs.2004.08.013
复制
发表时间：
2005-05-01
影响因子：
6
通讯作者：
Gaynor, JW
中科院分区：
文献类型：
--
作者：
Kirshbom, PM;Flynn, TB;Gaynor, JW
目的：我们试图定义的神经发育状况的学龄期幸存者的总异常肺静脉连接修复在babylation.Methods：所有学龄期幸存者的总异常肺静脉连接修复在一个单一的机构是合格的。30名儿童返回神经系统检查和神经发育tests.Results：总异常肺静脉连接修复的中位年龄为16天（范围，1-141天），测试时的年龄为11岁（范围，6-19岁）。肺静脉回流为心上型14例，心下型12例，心源性3例，混合型1例。6例术前存在阻塞性完全性肺静脉异位引流。所有修复术均采用循环停搏，中位持续时间为35分钟（范围：17-55分钟）。随访时，28%的患者存在小头畸形（头围5%）。神经肌肉检查可疑或异常27%。平均全面智商（95.3 ± 18.5）和言语智商（98.6 ± 20.2）与人群正常值没有差异，但操作智商（92.3 ± 16.9）显著低于人群正常值（P = 0.02）。精细运动技能和视觉-运动协调显著受损（凹槽钉板和视觉-运动整合测试P 0.01）。总异常肺静脉连接的患者也有困难的注意力测试（儿童日常注意力测试，P 0.01），但结果的记忆功能测试没有显着不同的人口normal.Conclusions：学龄婴儿总异常肺静脉连接修复的幸存者表现出显着的神经发育困难的发病率。精细运动功能，视觉运动整合和注意力是最常见的受影响领域。这些儿童的评估表明，以确定谁是在学习障碍的风险，谁可以受益于早期干预。
Objective: We sought to define the neurodevelopmental status of school-aged survivors of total anomalous pulmonary venous connection repaired during infancy.Methods: All school-aged survivors of total anomalous pulmonary venous connection repair performed at a single institution were eligible. Thirty children returned for neurologic examination and neurodevelopmental testing.Results: The median age at total anomalous pulmonary venous connection repair was 16 days (range, 1-141 days), and age at testing was 11 years (range, 6-19 years). Pulmonary venous return was supracardiac in 14 patients, infracardiac in 12 patients, cardiac in 3 patients, and mixed in I patient. Preoperative obstructed total anomalous pulmonary venous connection was present in 6 patients. Circulatory arrest was used in all repairs, with a median duration of 35 minutes (range, 17-55 minutes). At follow-up, microcephaly (head circumference < 5%) was present in 28%. Neuromuscular examination was suspect or abnormal in 27%. Mean Full-scale IQ (95.3 ± 18.5) and Verbal IQ (98.6 ± 20.2) were not different from population norms, but Performance IQ (92.3 ± 16.9) was significantly lower than population norms (P = .02). Fine motor skills and visual-motor coordination were significantly impaired (P <.01 for Grooved Pegboard and Test of Visual-Motor Integration). Patients with total anomalous pulmonary venous connection also had difficulty with tests of attention (Test of Everyday Attention for Children, P <.01), but results of tests of memory function were not significantly different from population norms.Conclusions: School-aged survivors of infant total anomalous pulmonary venous connection repair exhibit a significant incidence of neurodevelopmental difficulties. Fine motor function, visual-motor integration, and attention are the most commonly affected domains. Evaluation of these children is indicated to identify those who are at risk for learning disabilities and who could benefit from early intervention.