Abstract 12265: The Improvement of Hypoxia Correlates with Neuroanatomical and Developmental Outcomes in Infants with Transposition of the Great Arteries or Single Ventricle Physiology
OBJECTIVES: We performed a prospective longitudinal study of the neuroanatomical and developmental changes in infants with transposition of the great arteries (TGA) or single ventricle (SV) physiology, to identify variables in anatomical development of the brain associated with functional impairment. We hypothesized that infants with TGA, whose oxygenation improved after early surgical correction, would have better neuroanatomical and developmental outcome than those with SV physiology who continued to have hypoxia.
METHODS: Thirty-three infants with congenital heart defects, 23 with SV and 10 with TGA, were studied at around one year old (time 1) and three years old (time 2) by magnetic resonance imaging of the brain. Neurodevelomental assessment was performed at the same time.
RESULTS: The whole and frontal lobe volumes were significantly reduced in both groups at time 1 compared with normal controls (P<0.01). However, by time 2 whole and frontal brain volumes were normal in the TGA group, but remained significantly smaller (P<0.01) in the SV group. In agreement with these findings, the mental development index (MDI) was lower (P<0.05) at time 1 in both groups, but improved to normal levels at time 2 in the TGA group. In the SV group, both MDI and the psychomotor development index (PDI) were significantly decreased at both time 1 and at time 2 (P<0.01). These patients continued to experience hypoxia and multivariate analysis revealed that SpO2 was significantly associated with PDI, while patients who had undergone Blalock-Taussig shunt had smaller whole and regional brain volumes.
CONCLUSIONS: Neuroanatomical and developmental outcomes improve progressively in infants with TGA by 3years of age, unlike those with SV physiology. Impaired cerebral circulation and hypoxia may have significant impacts on brain growth and development in infants with critical CHD. This study encourages larger scale and longer follow up to clarify the significance of hypoxemia to impaired neuroanatomic development with functional outcome in CHD population.
- © 2011 by American Heart Association, Inc.