Child Development Center, University Children's Hospital, Zurich, Switzerland.
J Pediatr. 2011 Jun;158(6):984-9. doi: 10.1016/j.jpeds.2010.11.040. Epub 2011 Jan 14.
To assess long-term neurodevelopmental outcome of adolescents with congenital heart disease after open-heart surgery and to evaluate whether deficits are associated with cerebral injury detectable on magnetic resonance imaging (MRI).
We conducted a cohort study with longitudinal follow-up of 53 adolescents (mean age, 13.7 years; range, 11.4 to 16.9 years) who had undergone open-heart surgery with full-flow cardiopulmonary bypass during childhood and compared them with 41 age-matched controls. Assessment included conventional MRI and neurodevelopmental testing.
MRI abnormalities were detected in 11 of the 53 patients (21%), comprising predominately white matter abnormalities and volume loss. Neurodevelopmental outcome was impaired in several domains, including neuromotor, intellectual, and executive functions, as well as visuomotor perception and integration. Adolescents with cerebral abnormalities had greater impairment in most neurodevelopmental domains compared with those without cerebral abnormalities.
Cerebral abnormalities can be detected in a significant proportion of adolescents with corrected congenital heart disease. These abnormalities are found predominately in the white matter and are apparently of hypoxic-ischemic origin, most likely acquired during the neonatal period.
评估先天性心脏病患儿心脏直视手术后青少年的长期神经发育结局，并评估是否存在与磁共振成像（MRI）可检测到的脑损伤相关的缺陷。
我们进行了一项队列研究，对 53 名（平均年龄 13.7 岁；范围 11.4 至 16.9 岁）在儿童时期接受过体外循环全流量心脏直视手术的青少年进行了纵向随访，并将其与 41 名年龄匹配的对照组进行了比较。评估包括常规 MRI 和神经发育测试。
在 53 名患者中有 11 名（21%）发现了 MRI 异常，主要包括白质异常和体积损失。神经发育结局在多个领域受损，包括神经运动、智力和执行功能，以及视动知觉和整合。与无脑损伤的青少年相比，有脑损伤的青少年在大多数神经发育领域的损伤更大。
在大多数先天性心脏病已矫正的青少年中可以检测到脑异常。这些异常主要发生在白质中，且显然是缺氧缺血性起源，最有可能在新生儿期获得。
