Visual-Spatial Skills in Children After Open-Heart Surgery

Abstract

This study was part of a randomized clinical trial comparing the central nervous system effects of the two vital organ-support methods used in infant cardiac surgery: total circulatory arrest and low-flow cardiopulmonary bypass. The extent to which visual-spatial deficits are (1). associated with surgical and perioperative variables, (2). attributable to visual-perceptual, motor control, or metacognitive deficits, and (3). associated with adaptive difficulties at home or school was evaluated. The subjects were 155 8-year-old children with D-transposition of the great arteries who underwent the arterial switch operation before 3 months of age. As part of a comprehensive evaluation, the Rey-Osterrieth Complex Figure (ROCF) was administered. ROCF copy productions were classified as having a Basal Organization Level of 1 (low) or 2 or greater. A five-category clinical rating was also assigned. More than half of the children in the cohort (52%) had copy productions scored at Level 1, more than twice the expected frequency. The risk of having a low score was not associated with vital organ support method or other surgical variables. On the basis of comparisons of the relative fits of nested logistic regression models, poor visual-perceptual abilities were more predictive of having a Level 1 score than either motor control or metacognitive deficits. Children with poor copy production scores had lower mathematics scores, but not lower reading scores or poorer parent and teacher ratings of adaptive competence. The percentage of children receiving remedial school services was associated with ROCF clinical rating, ranging from 58% in the worst category to 8% in the best category. Visual-spatial deficits are common among children after infant heart surgery and seem to reflect visual-perceptual rather than motor control or metacognitive deficits. In addition, these deficits do not seem to be clearly associated with the intraoperative methods or postoperative events evaluated.

Persistence of visuo-constructional and executive deficits in adolescents after open-heart surgery

“…The quantitative scoring method by M&M failed to detect group differences regarding both copy and recall trials. Interestingly, our findings differ from those reported by Bellinger, Bernstein, et al (2003), who found significant ROCFT performance deficiencies in the copy condition in 8-year-old TGA patients using the B&W scoring. This difference may be due to a ceiling effect of the B&W scoring method at older ages.…”

“…Previous investigations have revealed mild to severe neurological impairments and motor deficits (Hovels-Gurich, Seghaye, Dabritz, Messmer, & von Bernuth, 1997;Limperopoulos et al, 2002;Majnemer et al, 2006), intellectual abilities in the low-average range (Forbess et al, 2002;Hovels-Gurich et al, 1997), and specific cognitive deficits (Bellinger, Wypij, et al, 2003;Brosig, Kuhn, & Tweddell, 2007) including visuomotor, visuospatial (Bellinger, Bernstein, Kirkwood, Rappaport & Newburger, 2003;Kirshbom et al, 2005;Majnemer et al, 2008) and executive dysfunctions (Majnemer et al, 2008). For the examination of visuospatial skills Bellinger, Bernstein, et al (2003) used the Rey-Osterrieth Complex Figure Test (ROCFT) in 8-year old children with transposition of the great arteries (Rey, 1941). They reported poor ROCFT performance in their cohort of 8-year-old CHD patients: 52% of the children in their cohort achieved the lowest level on a five-category clinical rating in the copy task (Bernstein & Waber, 1996).…”

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

“…Recent studies have shown that children with complex CHD have a significantly increased risk for DD in the areas of intelligence, [15][16][17]47,48 academic achievement, 5,16,17,48,49 language (development, expressive and receptive), 5,15,16,48,50,51 visual construction and perception, 5,16,49,[52][53][54][55] attention, 5,6,16,49,51,56 executive functioning, 51,57 fine motor skills, 15 …”

Promotion of Physical Activity for Children and Adults With Congenital Heart Disease

“…31 Motor skill delays are associated with sedentary lifestyles, 32 and gross, fine, and visual motor function delays are common among children with CHD. [33][34][35] Traditionally, it has been assumed that the motor delays that occur in children with CHD are related to early perioperative morbidity; however, the association of sedentary lifestyles with motor skill delays in children without a comparable medical history suggests that perioperative morbidities may not be the only reason for the prevalence of these delays in children with CHD. Although outcomes from cardiopulmonary exercise testing are linked to mortality, health-related fitness measures (Table 1) are associated with measures of health and daily living of more immediate concern to patients, including functional independence, quality of life, mobility disability, [36][37][38] and features of the metabolic syndrome.…”