Brain development of children with single ventricle physiology or transposition of the great arteries: A longitudinal observation study

Akiko Hiraiwa, Yukako Kawasaki, Keijiro Ibuki, Keiichi Hirono, Mie Matsui, Naoki Yoshimura, Hideki Origasa, Kenichi Oishi, Fukiko Ichida
Seminars in Thoracic and Cardiovascular Surgery 2019 July 12

OBJECTIVE: To define the correlation between neuroanatomic and developmental outcomes of children with single ventricle (SV) or transposition of the great arteries (TGA), a prospective longitudinal study was performed in preschool and school-age children.

METHOD: Twenty-seven children with congenital heart disease (CHD) (9, TGA; 18, SV) were included. Participants underwent 3-dimensional magnetic resonance imaging (MRI) and neurodevelopmental assessment at around 3 years (preschool age) and at 9 years (school age), and 48 healthy controls underwent MRI, and their data were used to derive best-fit models for normal brain volumes for comparisons with CHD patients.

RESULTS: Total brain volume (TBV) and regional brain volumes remained significantly smaller in SV children than in TGA children at both time points, though the growth slope of TBV was not significantly different between the SV and TGA groups. Although the psychomotor developmental index (PDI) at preschool was significantly lower in SV patients, the full-scale IQ (FSIQ) at school age was not significantly lower in SV patients. There was a strong correlation between FSIQ and TBV (r = 0.49, P = 0.005).

CONCLUSION: Despite the current best practices, persistently lower TBV was seen in SV patients until 9 years of age. For both the SV and TGA groups, TBV at 3 years was a strong predictor of TBV at 9 years. Since there was a correlation between TBV and IQ at 9 years, identification of factors that affect brain growth until 3 years will be imperative to improve patients' cognitive function at school age.


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