Neurodevelopmental Patterns in Congenital Heart Disease Across Childhood: Longitudinal Studies From Europe

Longitudinal studies are presented from centers in Aachen, Germany and Belfast, Northern Ireland, involving children with a range of congenital heart defects-cyanotic and acyanotic, surgically corrected and palliated and those who had undergone cardiopulmonary bypass versus transcatheter treatment only. While perceptual-motor deficits were most obvious in infancy, by middle childhood all subgroups had shown mild to moderate deficits in a range of higher-order mental abilities. A parallel process of some recovery in the former, but emergence of "late effects" in the latter, appears evident, and a neurodevelopmental phenotype is outlined. These deficits are significant enough to impact on academic and psychosocial outcomes for these children. Neurological frameworks for understanding recovery versus late effects, following insults to the developing brain, are considered. A four-factor model of risk, involving concomitant intrauterine brain abnormalities, peri- and postoperative management, preoperative hypoxemia, and environmental and family factors, is outlined.