Klouda Leda, Franklin Wayne J, Saraf Anita, Parekh Dhaval R, Schwartz David D
Department of Pediatrics, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, USA.
Congenit Heart Dis. 2017 Jan;12(1):91-98. doi: 10.1111/chd.12409. Epub 2016 Sep 21.
Congenital heart disease (CHD) can affect the developing central nervous system, resulting in neurocognitive and behavioral deficits. Preoperative neurological abnormalities as well as sequelae of the open heart operations required to correct structural abnormalities of the heart contribute to these deficits. There are few studies examining the neurocognitive functioning of adults with CHD. This study sought to investigate multiple domains of neurocognitive functioning in adult survivors of CHD who had childhood cardiac surgery with either moderate or severe disease complexity.
A total of 48 adults (18-49 years of age) who had undergone cardiac surgery for CHD prior to five years of age participated in the study. CHD severity was classified as moderate or severe according to the 32nd Bethesda Guidelines. A computerized battery of standardized neurocognitive tests (CNS-Vital Signs), a validated rating scale of executive functioning, and demographic questionnaires were administered.
There were no significant differences between the moderate CHD group and normative data on any cognitive measure. In contrast, the severe CHD group differed from norms in multiple domains: psychomotor speed, processing speed, complex attention, reaction time, and on the overall neurocognitive index. Number of surgeries was strongly related to worse executive functioning. There was no association between age at first surgery or time since last surgery and neuropsychological functioning. Number of surgeries was also unrelated to neurocognitive test performance.
Patients with severe CHD performed significantly worse on measures of processing speed, attention, and executive functioning. These findings may be useful in the long-term care of adults with congenital heart disease.
先天性心脏病（CHD）可影响发育中的中枢神经系统，导致神经认知和行为缺陷。术前神经异常以及纠正心脏结构异常所需的心脏直视手术后遗症是造成这些缺陷的原因。很少有研究考察患有CHD的成年人的神经认知功能。本研究旨在调查童年时期接受过中度或重度疾病复杂性心脏手术的成年CHD幸存者的多个神经认知功能领域。
共有48名在5岁之前接受过CHD心脏手术的成年人（年龄在18 - 49岁之间）参与了该研究。根据第32版贝塞斯达指南，CHD严重程度被分类为中度或重度。实施了一组计算机化的标准化神经认知测试（CNS - 生命体征）、一个经过验证的执行功能评定量表以及人口统计学调查问卷。
中度CHD组与任何认知测量的常模数据之间均无显著差异。相比之下，重度CHD组在多个领域与常模不同：心理运动速度、处理速度、复杂注意力、反应时间以及总体神经认知指数。手术次数与较差的执行功能密切相关。首次手术年龄或距上次手术时间与神经心理功能之间没有关联。手术次数也与神经认知测试表现无关。
重度CHD患者在处理速度、注意力和执行功能测量方面表现明显更差。这些发现可能对先天性心脏病成年人的长期护理有用。
