{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:28:57Z","timestamp":1787869737920,"version":"build-2784847793"},"reference-count":65,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,3,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Neurocognitive outcomes beyond childhood in people with a Fontan circulation are not well defined. This study aimed to investigate neurocognitive functioning in adolescents and adults with a Fontan circulation and associations with structural brain injury, brain volumetry, and postnatal clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In a binational study, participants with a Fontan circulation without a preexisting major neurological disability were prospectively recruited from the Australia and New Zealand Fontan Registry. Neurocognitive function was assessed by using Cogstate software in 107 participants with a Fontan circulation and compared with control groups with transposition of the great arteries (n=50) and a normal circulation (n=41). Brain MRI with volumetric analysis was performed in the participants with a Fontan circulation and compared with healthy control data from the ABIDE I and II (Autism Brain Imaging Data Exchange) and PING (Pediatric Imaging, Neurocognition, and Genetics) data repositories. Clinical data were retrospectively collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the participants with a Fontan circulation who had a neurocognitive assessment, 55% were male and the mean age was 22.6 years (SD 7.8). Participants with a Fontan circulation performed worse in several areas of neurocognitive function compared with those with transposition of the great arteries and healthy controls (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). Clinical factors associated with worse neurocognitive outcomes included more inpatient days during childhood, younger age at Fontan surgery, and longer time since Fontan procedure (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). Adults with a Fontan circulation had more marked neurocognitive dysfunction than adolescents with a Fontan circulation in 2 domains (psychomotor function,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.01 and working memory,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02). Structural brain injury was present in the entire Fontan cohort; the presence of white matter injury was associated with worse paired associate learning (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), but neither the presence nor severity of infarct, subcortical gray matter injury, and microhemorrhage was associated with neurocognitive outcomes. Compared with healthy controls, people with a Fontan circulation had smaller global brain volumes (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001 in all regions) and smaller regional brain volumes in most cerebral cortical regions (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). Smaller global brain volumes were associated with worse neurocognitive functioning in several domains (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.05). A significant positive association was also identified between global brain volumes and resting oxygen saturations (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u22640.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Neurocognitive impairment is common in adolescents and adults with a Fontan circulation and is associated with smaller gray and white matter brain volume. Understanding modifiable factors that contribute to brain injury to optimize neurocognitive function is paramount.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.120.048202","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T05:02:27Z","timestamp":1606194147000},"page":"878-891","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Neurocognitive Dysfunction and Smaller Brain Volumes in Adolescents and Adults With a Fontan Circulation"],"prefix":"10.1161","volume":"143","author":[{"given":"Charlotte E.","family":"Verrall","sequence":"first","affiliation":[{"name":"Heart Centre for Children (C.E.V., J.A., D.S.W.), The Children\u2019s Hospital at Westmead, Sydney, New South Wales, Australia."},{"name":"Sydney Medical School, Faculty of Medicine and Health (C.E.V., D.S.C., J.A., D.S.W., R.C.), University of Sydney, New South Wales, 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