シンポジウム9（III-S09）
周術期から遠隔期に渡る手術による精神・神経発達の評価

[III-S09-01] Outcomes of Children undergoing Cardiac Surgery: From the Perioperative Period to Long Term Follow Up

^○Anne Synnes (Neonatologist & Director, Neonatal Follow-Up Program Children's & Women's Health Centre of BC Clinical Professor University of British Columbia)

With 80% survival to adulthood, knowledge of long term outcomes associated with complex congenital heart disease (CHD) is increasingly important. Outcome is dependent on the type of CHD and the presence or absence of a genetic anomaly. Other risk factors include pre-operative abnormal neurological exam or brain MRI, lower birth weight, and poor condition at birth. Peri-operative risk factors include longer total intraoperative support time, post-operative seizures and additional surgeries. Higher socioeconomic status is protective. After adjustment for risk factors, small improvements in motor and cognitive development were seen from 1996-2009. Typically, motor and cognitive delays are seen in the first 2-3 years and mild cognitive, executive function, communication, social and behavioral impairments at school age. Severe disability is uncommon. Fetal MRI imaging has demonstrated abnormal brain growth and maturation associated with altered blood flow with complex CHD. MRI white matter injury patterns are similar to the preterm population suggesting similar vulnerabilities. Though intraoperative emboli or global ischemic insults may cause neurological injury, this explains < 5% of abnormal motor and cognitive delay. Most survivors have a reasonable quality of life though lower than healthy controls. Antenatal diagnosis and new fetal therapies are needed to make a significant impact on adverse neurodevelopmental outcomes. Support for parents to facilitate bonding and reduce stress is important as is developmental surveillance, screening and early intervention during childhood to promote the optimal health and well being of children born with complex CHD.