Original articleLong-term outcome of speech and language in children after corrective surgery for cyanotic or acyanotic cardiac defects in infancy
Introduction
Children after cardiac operations for congenital heart defects with cardiopulmonary bypass (CPB) with or without hypothermic cardiac arrest generally are at risk of later neurodevelopmental impairment in the domains of motor functions, intelligence, academic achievement, attention, speech, language and behavior.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 In particular, we recently showed that corrective surgery in infancy for tetralogy of Fallot (TOF) or ventricular septal defect (VSD) with combined circulatory arrest and low flow bypass is associated with reduced neurodevelopmental outcome with respect to motor function, formal intelligence and academic achievement.14 We additionally demonstrated that children with preoperative hypoxemia in infancy due to cyanotic heart defects are at higher risk for motor dysfunction14 and attentional dysfunction in the field of executive control15 than are children with cardiac insufficiency due to acyanotic heart defects.
As a milestone of child development, speech and language functions are of special interest with respect to the long-term follow-up of children after cardiac surgery. However, detailed systematic studies are rare in this field.2, 3, 11, 16 Given the high prevalence of speech and language dysfunctions in association with motor, cognitive and academic disabilities, speech and language dysfunctions are considered to be an important indicator of general developmental impairment.2, 17, 18, 19
The present prospective study was designed to test the hyposthesis that (1) the preoperative condition of hypoxemia in infancy is associated with worse outcomes in speech and language later in childhood, when compared to the condition of preoperative cardiac insufficiency; furthermore, (2) the relationship between speech and language outcomes and perioperative management, neurodevelopmental outcomes and sociodemographic status should be evaluated in a uniform cohort of children with TOF or VSD at age 5–11 years after corrective surgery in infancy.
Section snippets
Patient population
Between 1993 and 1999, 24 consecutive infants with a regular form of TOF and hypoxemia and 26 consecutive infants with a VSD and cardiac insufficiency had undergone primary corrective cardiac surgery in our institution at a mean age of 0.7 years with a standard deviation (SD) of 0.3. There was no early or late mortality. All patients with TOF had normal chromosomal status (46, XY and XX, respectively), and microdeletion 22q11.2 had been excluded by fluorescence in situ hybridization (FISH)
Parental report on speech and language history
Table 2 shows the results of the parents’ interview with respect to familial disposition for speech problems and to several aspects of speech development of their children. The proportions of reported developmental risks and disorders were high in most instances and exceeded the typical prevalence rates of 2–10% that are estimated for the global population.27 Almost half of the TOF children in contrast to 25% of the VSD children received speech/language therapy. However, none of the differences
Discussion
Our data are based on two homogeneous groups of infants with preoperative hypoxemia caused by TOF or with preoperative cardiac failure caused by a VSD, respectively, in whom preoperative, perioperative, and postoperative care was conducted according to standardized protocols. Follow-up examination of language and speech at mean age 7.6 years after corrective surgery in infancy was performed in 35 children who account for 70% of the operated patients. The outcome data were compared between the
Acknowledgments
The study was supported by grants of “Bundesverband Herzkranke Kinder e.V.” and “Herzkrankes Kind Aachen e.V.”, Aachen, Germany.
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