Cognitive Functions in Children with D-Transposition of Great Arteries Who Underwent Senning Procedure: A Pilot Single Center Study

Document Type : Original Research

Authors

1 Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt

2 Department of Pediatrics, Al Arish Hospital, North Sinai, Egypt

Abstract

Background: Dextro-transposition of the great arteries (D-TGA) is one of the common cyanotic congenital heart diseases, where aorta and pulmonary arteries arise from the right and left ventricle respectively. In 1958, Senning atrial switch operation was introduced for D-TGA. Long-term hemodynamic circulatory complications in D-TGA may present from cyanosis, preoperative hypoxia, post-operative techniques, which may impact neurocognitive development.
Aim of work: to assess cognitive function in children with D-TGA who underwent Senning atrial switch.
Subjects and Methods: This study included 29 children who were diagnosed as D-TGA and underwent Senning atrial switch procedure compared to 29 normal matched controls. Cognitive function was assessed using the Wechsler Intelligence Scale for Children (WISC IV).
Results: Those with D-TGA had lower total IQ (mean ± SD was 75.44 ± 15.57 and 84.6± 9.2 respectively) (p= 0.005) and lower performance test scores (mean ± SD was 27.5 ± 11.1 and 37.7± 8.2 respectively) (p< 0.001). Ten (34.5%) patients had mild mental retardation (mean ± SD IQ score= 60.3± 5.02) and one (3.4%) had moderate mental retardation (IQ score= 48). The performance subtest scores; picture arrangement, block design and coding were statistically lower among those withD-TGA than the control group (p = 0.002, p=0.008 and p<0.001 respectively). Total verbal scores and verbal subtests scores of the cases was not different than the control group (p = 0.444).
Conclusion: This study highlights the significant cognitive challenges faced by children with D-TGA, particularly in non-verbal domains. While verbal abilities remained intact, total IQ and performance scores were significantly impaired in comparison to control group. The effect of Senning operative intervention on the cognitive functions, is not clear. These findings highlight the need for routine cognitive monitoring, tailored educational support, multidisciplinary care approach, as well as parental and caregiver education for D-TGA children.

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