Laboratoire de Psychopathologie et Neuropsychologie, Université Paris 8-Paris Lumières-CNRS, Saint-Denis, France.
Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2018 Mar;105(3):830-836. doi: 10.1016/j.athoracsur.2017.06.055. Epub 2017 Oct 21.
Neurodevelopmental impairments have frequently been described in children and adolescents with dextro-transposition of the great arteries (d-TGA). The arterial switch operation (ASO) to correct d-TGA has been used for more than 30 years, and more than 90% of these patients now reach adulthood. However, very little is known about their long-term functional outcomes. The present study investigated neurocognitive outcomes and the prevalence of psychiatric disorders in adults with d-TGA corrected by ASO.
Neurocognitive functioning was comprehensively assessed (general intellectual functioning, language, attention, visual-spatial skills, executive functions, memory) in 67 adults (59.7% men) with d-TGA (aged 22.9 ± 3.4 years) and in 43 healthy individuals. The prevalence of psychiatric disorders, including depression and anxiety, was evaluated using a structured diagnostic interview. We also analyzed patient- and operative-related risk factors associated with outcomes.
Compared with the general population and the control group, adults with d-TGA displayed reduced performance in tasks assessing attention, visual-spatial skills, executive functions, and memory (all p < 0.05). Compared with controls, patients had also a higher lifetime prevalence of depression (43% vs 19%, p = 0.008) and anxiety disorders (54% vs 33%, p = 0.025). Predictors of long-term outcomes included gender and parental socioeconomic and educational status (all p < 0.05).
Adults who have undergone a neonatal ASO to correct d-TGA have an increased risk of cognitive deficits and psychiatric disorders. Evaluation of long-term neuropsychological and psychosocial outcomes in early adulthood is a crucial step to anticipate for adapted treatment strategies in adults with congenital heart disease.
右旋型大动脉转位（d-TGA）患儿和青少年常伴有神经发育障碍。用于纠正 d-TGA 的动脉调转手术（ASO）已应用了 30 多年，超过 90%的此类患者现在已进入成年期。然而，对于他们的长期功能预后却知之甚少。本研究调查了通过 ASO 矫正 d-TGA 的成年人的神经认知结局和精神障碍的患病率。
我们对 67 名（59.7%为男性）d-TGA 成年患者（年龄 22.9±3.4 岁）进行了全面的神经认知功能评估（总体智力功能、语言、注意力、视觉空间技能、执行功能、记忆），并纳入了 43 名健康个体作为对照组。使用结构化诊断访谈评估了包括抑郁和焦虑在内的精神障碍的患病率。我们还分析了与结局相关的患者和手术相关的风险因素。
与一般人群和对照组相比，d-TGA 成年患者在注意力、视觉空间技能、执行功能和记忆任务中的表现均较差（均 p<0.05）。与对照组相比，患者的终生抑郁患病率（43%比 19%，p=0.008）和焦虑障碍患病率（54%比 33%，p=0.025）也更高。长期结局的预测因素包括性别以及父母的社会经济和教育地位（均 p<0.05）。
接受新生儿 ASO 纠正 d-TGA 的成年人存在认知缺陷和精神障碍的风险增加。在成年早期评估长期神经心理学和心理社会结局是预测先天性心脏病成年患者适应性治疗策略的关键步骤。
