Abstract
In children with tetralogy of Fallot (TOF), there is a risk of brain injury even if intracardiac deformities are corrected. This population follow-up study aimed to identify the correlation between cerebral morphology changes and cognition in postoperative school-aged children with TOF. Resting-state functional magnetic resonance imaging (rs-fMRI) and the Wechsler Intelligence Scale for Children–Chinese revised edition (WISC-CR) were used to assess the difference between children with TOF and healthy children (HCs). Multiple linear regression showed that the TOF group had a lower verbal intelligence quotient (VIQ, 95.000 ± 13.433, p = 0.001) than the HC group and that VIQ had significant positive correlations with the cortical thickness of both the left precuneus (p < 0.05) and the right caudal middle frontal gyrus (p < 0.05) after adjustment for preoperative SpO2, preoperative systolic blood pressure (SBP), preoperative diastolic blood pressure (DBP) and time of aortic override (AO). Our results suggested that brain injury induced by TOF would exert lasting effects on cortical and cognitive development at least to school age. This study provides direct evidence of the relationship between cortical thickness and VIQ and of the need for strengthened verbal training in school-aged TOF patients after corrective surgery.
Highlights
Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease (CHD) [1], accounting for almost 3.5% of CHD cases [2]
white matter volume (WMV) (438.000 ± 56.978), Brain tissue volume (BTV) (1,121.800 ± 129.049), total intracranial volume (TIV) (1,368.100 ± 151.542) and whole-brain cortical average thickness (CAT, 2.750 ± 0.061) were reduced in children with tetralogy of Fallot (TOF) compared with healthy children
After analyzing the correlation among cerebral morphology changes, intelligence quotient (IQ) and hospital records (Tables 3, 4), we found that preoperative SpO2, preoperative systolic blood pressure (SBP), preoperative diastolic blood pressure (DBP) and time of aortic override (AO) were related to morphology changes
Summary
Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease (CHD) [1], accounting for almost 3.5% of CHD cases [2]. Under 1% of TOF patients who do not have surgery survive to 40 years old [5], whereas, those who undergo surgery before 5 years old have a 30-year survival rate of 90% [6]. Mortality declines after surgery, survivors still face a variety of complications [7], such as myocardial damage [2], pulmonary incompetence [8], aortic dilation and arrhythmias [9]. Over 50% of TOF patients exhibit cerebral damage [10], which may manifest as declines in cognitive, psychosocial, and behavioral ability [11, 12] and influence the patients’ long-term quality of life [13].
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