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(Circulation. 2001;104:I-138.)
© 2001 American Heart Association, Inc.

Surgery for Congenital Heart Disease

General Health Status of Children With D-Transposition of the Great Arteries After the Arterial Switch Operation

Carolyn Dunbar-Masterson, RN, BSN; David Wypij, PhD; David C. Bellinger, PhD, MSc; Leonard A. Rappaport, MD; Annette L. Baker, RN, PNP; Richard A. Jonas, MD; Jane W. Newburger, MD, MPH

Departments of Neurology (D.C.B.), Medicine (L.A.R.), Cardiology (J.W.N., A.L.B., C.D.-M.), and Cardiovascular Surgery (R.A.J.), Children’s Hospital, Boston, Mass; Departments of Neurology (D.C.B.), Pediatrics (L.A.R., J.W.N.), and Surgery (R.A.J.), Harvard Medical School, Boston, Mass; and Department of Biostatistics (D.W.), Harvard School of Public Health, Boston, Mass.

Correspondence to Jane W. Newburger, MD, Department of Cardiology, Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail jane.newburger{at}tch.harvard.edu

Background— To study the long-term impact on general health status of D-transposition of the great arteries (D-TGA) after the arterial switch operation (ASO) during infancy, we asked parents to complete the Child Health Questionnaire, Parent Form-50 when their children were 8 years old.

Methods and Results— Of 160 eligible patients, questionnaires were completed for 155 subjects (96%). Median age at surgery was 6 days (range 1 to 67 days), and median age at completion of the Child Health Questionnaire was 8.1 years (7.6 to 10.0 years). Subsequent to questionnaire completion, children underwent psychometric testing. Mean Physical Health Summary and Psychosocial Summary scores were 54.0±6.1 and 49.7±9.9, respectively, which were similar to those of normal subjects. Compared with the normative sample, parents of D-TGA patients reported more problems with attention, learning, and speech, as well as greater frequency of developmental delay (P<0.001 for each). Worse Psychosocial Summary scores were significantly associated with lower full-scale IQ (P=0.001) and lower achievement in reading (P=0.005) and math (P=0.007). Worse Physical Health Summary scores were associated with longer hospital stay after the ASO (P=0.02). General health status scores were not significantly related to presence of ventricular septal defect, age at surgery, perfusion variables during the ASO, sex, or history of cardiac reoperation.

Conclusions— At age 8 years, children with D-TGA after ASO have an overall physical and psychosocial health status similar to that of the general population. Lower IQ and academic achievement are associated with worse psychosocial health status, whereas longer hospital course after initial surgery is associated with worse physical health status.

Key Words: heart defects, congenital • transposition of great vessels • surgery • pediatrics • quality of life