ORIGINAL ARTICLE

Long term behavioural outcome after neonatal arterial switch operation for transposition of the great arteries

H H Hövels-Gürich¹, K Konrad², M Wiesner¹, R Minkenberg³, B Herpertz-Dahlmann², B J Messmer⁴, G von Bernuth¹

¹ Department of Paediatric Cardiology, Aachen University of Technology, Pauwelsstr. 30, D-52057 Aachen, Germany
² Department of Child and Adolescent Psychiatry, Aachen University of Technology
³ Institute for Medical Research and Information Processing, Repges & Partner, D-52057 Aachen, Germany
⁴ Department of Thoracic and Cardiovascular Surgery, Aachen University of Technology

Correspondence to:
Correspondence to:
Dr H H Hövels-Gürich, Department of Paediatric Cardiology, Aachen University of Technology, Pauwelsstr. 30, D-52057 Aachen, Germany;
hhoevels-guerich{at}ukaachen.de

Aims: To evaluate behavioural outcome and quality of life in children aged 8–14 years after neonatal arterial switch operation for transposition of the great arteries.

Methods: Sixty children operated as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass were evaluated at age 7.9–14.3 years by the Child Behaviour Checklist (CBCL) and the Inventory for the Assessment of the Quality of Life in Children and Adolescents (IQCL).

Results: Parent reported behavioural outcome on all CBCL problem and competence scores was worse, whereas quality of life on self reported IQCL scores was not reduced compared to the normal population. On multivariate analysis, severe preoperative hypoxia was related to parent reported social problems; peri- and postoperative cardiocirculatory insufficiency was associated with internalising, externalising, attention, and total behavioural problems. Reduced expressive language was associated with total behavioural problems, and poor academic achievement was related to parent reported deficits in school performance. Impaired neurological status and reduced endurance capacity both predicted self reported stress by illness.

Conclusions: The neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with parent reported long term behavioural impairment, but not with self reported general reduction in quality of life. This discrepancy may be a result of different perception of illness. In our experience, increased risk of long term psychosocial maladjustment after neonatal corrective cardiac surgery is related to the presence of neurological impairment and reduced endurance capacity.

Keywords: behavioural problems; quality of life; transposition of the great arteries; cardiac surgery

Abbreviations: ASO, arterial switch operation; CBCL, Child Behaviour Checklist; CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest; IQCL, Inventory for the Assessment of the Quality of Life in Children and Adolescents; TGA, transposition of the great arteries; VSD, ventricular septal defect

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