Abstract
Despite intracardiac malformation correction, children with Tetralogy of Fallot (TOF) may still suffer from brain injury. This cross-sectional study was primarily designed to determine the relationship between blood oxygenation level-dependent (BOLD) signal changes after surgery and cognition in school-aged children with TOF. To evaluate the differences between TOF children (n = 9) and healthy children (n = 9), resting-state functional magnetic resonance imaging (rs-fMRI) and the Wechsler Intelligence Scale for Children–Chinese revised edition (WISC-CR) were conducted in this study. The results showed that TOF children had a lower full-scale intelligence quotient (FSIQ, 95.444 ± 5.354, p = 0.022) and verbal intelligence quotient (VIQ, 92.444 ± 4.708, p = 0.003) than healthy children (FSIQ = 118.500 ± 4.330;VIQ = 124.250 ± 4.404), and that significant differences in regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) existed between the two groups. Besides, VIQ had significantly positive correlations with the decreased ALFF value of the middle inferior occipital gyrus (MIOG, beta = 0.908, p = 0.012) after fully adjusting for all covariates. In addition, elevated ReHo values of the left and right precuneus were positively related to ALFF in the MIOG. This study revealed that brain injury substantially influences neural activity and cognition in postoperative TOF children, providing direct evidence of an association between BOLD signal changes and the VIQ and prompting further attention to language development in TOF children.
Highlights
Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital cardiac malformations (Diaz-Frias and Guillaume, 2020), accounting for approximately 5% of all congenital heart diseases (CHDs) (Apitz et al, 2009)
Abnormal regional homogeneity (ReHo) values in the PCUN.L and PCUN.R were positively related to amplitude of low-frequency fluctuation (ALFF) values in the MIOG.L, which may compensate for the verbal intelligence quotient (VIQ) caused by low ALFF values in MIOG.L
Based on units of neurons, the association between neuronal activity and cognition was determined in this study, and combined with the existing research, the underlying mechanisms of a low VIQ induced by abnormal ReHo and ALFF values were explored
Summary
Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital cardiac malformations (Diaz-Frias and Guillaume, 2020), accounting for approximately 5% of all congenital heart diseases (CHDs) (Apitz et al, 2009). Less than 1% of patients survive to 40 years old naturally (Ai et al, 2018), but nearly 90% of patients with early diagnosis and surgical treatment will go on to survive (Hickey et al, 2009); adverse outcomes can still occur many years after cardiac surgery, including heart failure, arrhythmia, and right ventricular outflow tract reobstruction (Apitz et al, 2009). Functional magnetic resonance imaging (fMRI) has been applied to identify neurodevelopmental disabilities more accurately (Ma et al, 2020)
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