1 Child Development Centre, University Children’s Hospital, Zurich, Switzerland
2 Department of Neurology, University Hospital, Zurich, Switzerland3 Sleep Research Centre, University Children’s Hospital, Zurich, Switzerland
4 Clinic of Neonatology, University Hospital, Zurich, Switzerland
3 Sleep Research Centre, University Children’s Hospital, Zurich, Switzerland
5 Centre for MR-Research, University Children’s Hospital, Zurich, Switzerland6 Centre for Integrative Human Physiology, University of Zurich, Switzerland7 Institute of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
8 Division of Cardiology, University Children’s Hospital, Zurich, Switzerland
1 Child Development Centre, University Children’s Hospital, Zurich, Switzerland6 Centre for Integrative Human Physiology, University of Zurich, Switzerland
Patients with complex congenital heart disease are at risk for neurodevelopmental impairments. Evidence suggests that brain maturation can be delayed and pre- and postoperative brain injury may occur, and there is limited information on the long-term effect of congenital heart disease on brain development and function in adolescent patients. At a mean age of 13.8 years, 39 adolescent survivors of childhood cardiopulmonary bypass surgery with no structural brain lesions evident through conventional cerebral magnetic resonance imaging and 32 healthy control subjects underwent extensive neurodevelopmental assessment and cerebral magnetic resonance imaging. Cerebral scans were analysed quantitatively using surface-based and voxel-based morphometry. Compared with control subjects, patients had lower total brain (P = 0.003), white matter (P = 0.004) and cortical grey matter (P = 0.005) volumes, whereas cerebrospinal fluid volumes were not different. Regional brain volume reduction ranged from 5.3% (cortical grey matter) to 11% (corpus callosum). Adolescents with cyanotic heart disease showed more brain volume loss than those with acyanotic heart disease, particularly in the white matter, thalami, hippocampi and corpus callosum (all P-values < 0.05). Brain volume reduction correlated significantly with cognitive, motor and executive functions (grey matter: P < 0.05, white matter: P < 0.01). Our findings suggest that there are long-lasting cerebral changes in adolescent survivors of cardiopulmonary bypass surgery for congenital heart disease and that these changes are associated with functional outcome.