Adolescents with d-transposition of the great arteries corrected with the arterial switch procedure: neuropsychological assessment and structural brain imaging.

BACKGROUND: We report neuropsychological and structural brain imaging assessments in children 16 years of age with d-transposition of the great arteries who underwent the arterial switch operation as infants. Children were randomly assigned to a vital organ support method, deep hypothermia with either total circulatory arrest or continuous low-flow cardiopulmonary bypass. METHODS AND RESULTS: Of 159 eligible adolescents, 139 (87%) participated. Academic achievement, memory, executive functions, visual-spatial skills, attention, and social cognition were assessed. Few significant treatment group differences were found. The occurrence of seizures in the postoperative period was the medical variable most consistently related to worse outcomes. The scores of both treatment groups tended to be lower than those of the test normative populations, with substantial proportions scoring ≥1 SDs below the expected mean. Although the test scores of most adolescents in this trial cohort are in the average range, a substantial proportion have received remedial academic or behavioral services (65%). Magnetic resonance imaging abnormalities were more frequent in the d-transposition of the great arteries group (33%) than in a referent group (4%). CONCLUSIONS: Adolescents with d-transposition of the great arteries who have undergone the arterial switch operation are at increased neurodevelopmental risk. These data suggest that children with congenital heart disease may benefit from ongoing surveillance to identify emerging difficulties. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000470.

Volatile cardioplegia: fast normothermic cardiac arrest induction and recovery with halothane in isolated rat hearts

To study the effect of halothane as a cardioplegic agent, ten Wistar rats were anesthetized by ether inhalation and their hearts were perfused in a Langgendorff system with Krebs-Henseleit solution (36 graus Celsius; 90 cm H2O pressure). After a 15-min period for stabilization the control values for heart rate, force (T), dT/dt and coronary flow were recorded and a halothane-enriched solution (same temperature and pressure) was perfused until cardiac arrest was obtained. The same Krebs-Henseleit solution was reperfused again and the parameters studied were recorded after 1,3,5,10,20 and 30 min. Cardiac arrest occurred in all hearts during the first two min of perfusion with halothanebubbled solution. One minute after reperfusion without halothane, the following parameters reported in terms of control values were obtained: 90.5 percent of control heart rate (266.9 + 43.4 to 231.5 + 71.0 bpm), 20.2 percent of the force (1.83 + 0.28 to 0.37 + 0.25 g), 19.8 percent of dT/dt (46.0 + 7.0 to 9.3 + 6.0 g/s) and 90.8 percent of coronary flow (9.9 + 1.5 to 9.4 + 1.5 ml/min). After 3 min of perfusion they changed to 99.0 percent heart rate (261.0 + 48.2), 98.9 percent force (1.81 + 0.33), 98.6 dT/dt (45.0 + 8.2) and 94.8 percent coronary flow (9.3 + 1.4). At 5 min 100.8 percent (267.0 + 40.6) heart rate, 105.0 percent (1.92 + 0.29) force and 104.4 percent (48.2 + 7.2) dT/dt were recorded and maintained without significant differences (P>0.01) until the end of the experiment. These data demonstrate that volatile cardioplegia with halothane is an effective technique for fast induction of and prompt recovery from normothermic cardiac arrest of the rat heart.