Matos Samantha M, Sarmento Sofia, Moreira Sara, Pereira Maria Manuela, Quintas Jorge, Peixoto Bruno, Areias José Carlos, Areias Maria Emília G
Department of Psychology, Higher Institute for Health Sciences-North (CESPU), Gandra; IINFACTS (CESPU), Gandra.
Congenit Heart Dis. 2014 Sep-Oct;9(5):373-81. doi: 10.1111/chd.12152. Epub 2013 Dec 3.
Our aims were to evaluate the neurocognitive performance in adolescents with congenital heart disease (CHD) and to determine whether parameters of fetal development evaluated in neonates, such as head circumference, length, weight, and Apgar scores, are somehow related to their neurocognitive performance.
We evaluated 77 CHD patients (43 males) aged from 13 to 18 years old (mean = 15.04 ± 1.86), 46 cyanotic, 23 with tetralogy of Fallot (TF), 23 with transposition of the great arteries (TGA) and 31 acyanotic with ventricular septal defect (VSD) enrolled in this study. The control group included 16 healthy children (11 males) ages ranging from 13 to 18 years old (mean = 15.69 years ± 1.44 years). All assessment measures for CHD patients were once obtained in a tertiary hospital; the control group was evaluated in school. Neuropsychological assessment included Wechsler's Digit Test, direct and reverse (WDD and WDR) and Symbol Search, Rey's Complex Figure (RCF), BADS's Key Searching Test, Color-Word Stroop Test (CWS), Trail Making Test (TMT), and Logical Memory Task (LMT). We evaluated some fetal parameters, such as head circumference, weight and length assessed at birth, and neonatal parameters, such as Apgar scores at 1 and 5 minutes after birth. We also registered some surgical parameters, such as the age at first operation and the number of surgeries.
CHD patients compared with control group showed lower scores on every test, except for logical memory task. Patients with VSD when compared with patients with TF and TGA showed better results in all neuropsychological tests, although the only significant differences were in RCF, copy (F = 4936; P = .010). Several correlations were apparent between fetal/neonatal parameters and neuropsychological abilities in each type of CHD. However, head circumference at birth stands as the main correlation with cognitive development later on in all kinds of CHD (WDD: rho = .339, P = .011; RCF, copy: rho = 0.297, P = .027; CWS, interference: rho = 0.283, P = .036; TMT-A: rho = -0.321, P = .017). We analyzed the predicting relevance of several variables to cognitive performance of adolescents with CHD and confirmed that "cyanosis" stands as the main predictor (â = -4.758; t = -2.622; P = .011).
Adolescents with CHD have worse neuropsychological performance than the control group, mainly the cyanotic patients. Fetal circulation seems to have impact on cerebral and somatic growth, predicting cognitive impairment in adolescents with CHD.
我们的目的是评估先天性心脏病（CHD）青少年的神经认知表现，并确定新生儿期评估的胎儿发育参数，如头围、身长、体重和阿氏评分，是否与他们的神经认知表现存在某种关联。
我们评估了77例年龄在13至18岁（平均 = 15.04 ± 1.86岁）的CHD患者（43例男性），其中46例为青紫型，23例为法洛四联症（TF），23例为大动脉转位（TGA），31例非青紫型室间隔缺损（VSD）纳入本研究。对照组包括16名年龄在13至18岁（平均 = 15.69岁 ± 1.44岁）的健康儿童（11例男性）。CHD患者的所有评估指标均在一家三级医院一次性获取；对照组在学校进行评估。神经心理学评估包括韦氏数字广度测验（顺背和倒背）（WDD和WDR）、符号搜索、雷氏复杂图形测验（RCF）、BADS钥匙搜索测验、色词斯特鲁普测验（CWS）、连线测验（TMT）和逻辑记忆任务（LMT）。我们评估了一些胎儿参数，如出生时评估的头围、体重和身长，以及新生儿参数，如出生后1分钟和5分钟的阿氏评分。我们还记录了一些手术参数，如首次手术年龄和手术次数。
与对照组相比，CHD患者在每项测试中得分较低，但逻辑记忆任务除外。与TF和TGA患者相比，VSD患者在所有神经心理学测试中表现更好，尽管唯一显著差异在于RCF临摹（F = 4.936；P = 0.010）。每种类型的CHD中，胎儿/新生儿参数与神经心理学能力之间存在若干明显的相关性。然而，出生时的头围是各类CHD后期认知发展的主要相关因素（WDD：rho = 0.339，P = 0.011；RCF临摹：rho = 0.297，P = 0.027；CWS干扰：rho = 0.283，P = 0.036；TMT - A：rho = -0.321，P = 0.017）。我们分析了几个变量对CHD青少年认知表现的预测相关性，并确认“青紫”是主要预测因素（β = -4.758；t = -2.622；P = 0.011）。
CHD青少年的神经心理学表现比对照组差，主要是青紫型患者。胎儿循环似乎对大脑和身体生长有影响，预测CHD青少年的认知障碍。
