Impact of fetal development on neurocognitive performance of adolescents with cyanotic and acyanotic congenital heart disease

Abstract

Background: Our aims were to evaluate the neurocognitive performance in adolescents with congenital heart disease (CHD) and to determine whether parameters of fetal development evaluated in neonates, such as head circumference, length, weight, and Apgar scores, are somehow related to their neurocognitive performance.

Methods: We evaluated 77 CHD patients (43 males) aged from 13 to 18 years old (mean = 15.04 ± 1.86), 46 cyanotic, 23 with tetralogy of Fallot (TF), 23 with transposition of the great arteries (TGA) and 31 acyanotic with ventricular septal defect (VSD) enrolled in this study. The control group included 16 healthy children (11 males) ages ranging from 13 to 18 years old (mean = 15.69 years ± 1.44 years). All assessment measures for CHD patients were once obtained in a tertiary hospital; the control group was evaluated in school. Neuropsychological assessment included Wechsler's Digit Test, direct and reverse (WDD and WDR) and Symbol Search, Rey's Complex Figure (RCF), BADS's Key Searching Test, Color-Word Stroop Test (CWS), Trail Making Test (TMT), and Logical Memory Task (LMT). We evaluated some fetal parameters, such as head circumference, weight and length assessed at birth, and neonatal parameters, such as Apgar scores at 1 and 5 minutes after birth. We also registered some surgical parameters, such as the age at first operation and the number of surgeries.

Results: CHD patients compared with control group showed lower scores on every test, except for logical memory task. Patients with VSD when compared with patients with TF and TGA showed better results in all neuropsychological tests, although the only significant differences were in RCF, copy (F = 4936; P = .010). Several correlations were apparent between fetal/neonatal parameters and neuropsychological abilities in each type of CHD. However, head circumference at birth stands as the main correlation with cognitive development later on in all kinds of CHD (WDD: rho = .339, P = .011; RCF, copy: rho = 0.297, P = .027; CWS, interference: rho = 0.283, P = .036; TMT-A: rho = -0.321, P = .017). We analyzed the predicting relevance of several variables to cognitive performance of adolescents with CHD and confirmed that "cyanosis" stands as the main predictor (â = -4.758; t = -2.622; P = .011).

Conclusions: Adolescents with CHD have worse neuropsychological performance than the control group, mainly the cyanotic patients. Fetal circulation seems to have impact on cerebral and somatic growth, predicting cognitive impairment in adolescents with CHD.

Keywords: Congenital Heart Disease; Fetal Development; Neonatal Variables; Neurocognitive Functioning.