{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T20:27:37Z","timestamp":1772137657319,"version":"3.50.1"},"reference-count":55,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,11,18]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">To assess childhood neurocognitive outcomes in a contemporary Fontan cohort and to identify neurodevelopmental risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This retrospective cohort study enrolled patients with a single ventricle born between 2004 and 2019 receiving standardized neurocognitive testing with age\u2010appropriate Wechsler intelligence scales after staged univentricular palliation. Demographic, surgical, and perioperative data were collected to evaluate neurodevelopmental risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Data from 204 patients assessed at 5.0 (interquartile range, 4.5\u20136.1) years of age were analyzed. Full\u2010scale IQ (FSIQ) was in the lower normal range (93.5\u00b112.3) but below population norms (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Severe cognitive impairment (FSIQ &lt;70) was noted in 4% and moderate impairment (FSIQ 84\u201370) in 20.5%. FSIQ was not different between hypoplastic left heart syndrome (n=112) and other univentricular heart defects (93.7\u00b112.6 versus 93.3\u00b111.9,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.821). Use of cardiopulmonary bypass for neonatal palliation (n=142) was not related to lower FSIQ (93.7\u00b112.8 versus 92.9\u00b111.0,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.670). Microcephaly, lower parental education level, and complications before and length of postoperative stay after neonatal palliation were independently associated with FSIQ below average. Head circumference\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      \u2010score, higher parental education, and shorter cumulative hospital stay were related with favorable outcome (FSIQ&gt;100).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">In this contemporary Fontan cohort, mean FSIQ was in the low normal range but with a higher proportion of patients with intellectual impairment. Hypoplastic left heart syndrome or use of cardiopulmonary bypass for neonatal palliation was not associated with lower FSIQ scores. Preoperative condition and patient\u2010related factors were more important determinants of cognitive function than variables related to surgical palliation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.043769","type":"journal-article","created":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T06:15:01Z","timestamp":1762928101000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Childhood Neurocognitive Outcomes in Patients With Fontan Circulation"],"prefix":"10.1161","volume":"14","author":[{"given":"Claudia","family":"Jessen","sequence":"first","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katy","family":"Rinne","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7406-8006","authenticated-orcid":false,"given":"Inga","family":"Voges","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ina","family":"Twelkemeyer","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliane","family":"Schulze\u2010Nagel","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8038-9313","authenticated-orcid":false,"given":"Jens","family":"Scheewe","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5991-2106","authenticated-orcid":false,"given":"Tim","family":"Attmann","sequence":"additional","affiliation":[{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck","place":["Germany"]},{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anselm","family":"Uebing","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1575-2865","authenticated-orcid":false,"given":"Jan H.","family":"Hansen","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig\u2010Holstein, Campus Kiel","place":["Germany"]},{"name":"DZHK (German Center for Cardiovascular Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318265ee8a"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ppedcard.2010.06.011"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019881"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.064113"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-3825"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsz021"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013632"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.826349"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-050875"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001211"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2004.02.007"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2019.08.003"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezx119"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.12.020"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-924458"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1108\/S0195-6310(2013)0000030017"},{"key":"e_1_3_1_18_2","volume-title":"Hamburg Wechsler Intelligenztest f\u00fcr Kinder IV (HAWIK\u2010IV)","author":"Petermann F","year":"2010","unstructured":"Petermann F, Petermann U. Hamburg Wechsler Intelligenztest f\u00fcr Kinder IV (HAWIK\u2010IV). Bern: Huber; 2010."},{"key":"e_1_3_1_19_2","volume-title":"Wechsler Intelligence Scale for Children \u2013 fourth edition (WISC\u2010IV)","author":"Wechsler D","year":"2011","unstructured":"Wechsler D. In: Petermann F, Petermann U, eds Wechsler Intelligence Scale for Children \u2013 fourth edition (WISC\u2010IV). G\u00f6ttingen: Hogrefe; 2011."},{"key":"e_1_3_1_20_2","volume-title":"Wechsler Intelligence Scale for Children \u2013 fifth edition (WISC\u2010V)","author":"Wechsler D","year":"2017","unstructured":"Wechsler D. In: Petermann F, ed Wechsler Intelligence Scale for Children \u2013 fifth edition (WISC\u2010V). Frankfurt a. M.: Pearson; 2017."},{"key":"e_1_3_1_21_2","volume-title":"Hannover\u2010Wechsler\u2010Intelligenztest f\u00fcr das Vorschulalter\u2010 III (HAWIVA\u2010III)","author":"Ricken G","year":"2007","unstructured":"Ricken G, Fritz A, Schuck KD, Preu\u00df U. Hannover\u2010Wechsler\u2010Intelligenztest f\u00fcr das Vorschulalter\u2010 III (HAWIVA\u2010III). Bern: Huber; 2007."},{"key":"e_1_3_1_22_2","volume-title":"Wechsler Preschool and Primary Scale of Intelligence \u2013 third edition (WPPSI\u2010III) (German Version)","author":"Petermann F","year":"2009","unstructured":"Petermann F. Wechsler Preschool and Primary Scale of Intelligence \u2013 third edition (WPPSI\u2010III) (German Version). Frankfurt a. M.: Pearson Assessment; 2009."},{"key":"e_1_3_1_23_2","volume-title":"Wechsler Preschool and Primary Scale of Intelligence \u2013 fourth edition (WPPSI\u2010IV)","author":"Wechsler D","year":"2018","unstructured":"Wechsler D. In: Petermann F, Daseking M, eds Wechsler Preschool and Primary Scale of Intelligence \u2013 fourth edition (WPPSI\u2010IV). Frankfurt a. M.: Pearson Assessment; 2018."},{"key":"e_1_3_1_24_2","volume-title":"Kognitiver Entwicklungstest f\u00fcr das Kindergartenalter (KET\u2010KID)","author":"Daseking M","year":"2009","unstructured":"Daseking M, Petermann F. Kognitiver Entwicklungstest f\u00fcr das Kindergartenalter (KET\u2010KID). G\u00f6ttingen: Hogrefe; 2009."},{"key":"e_1_3_1_25_2","volume-title":"DISYPS\u2010II. Diagnostik\u2010System f\u00fcr psychische St\u00f6rungen nach ICD\u201010 und DSM\u2010IV f\u00fcr Kinder und Jugendliche\u2010II","author":"D\u00f6pfner M","year":"2008","unstructured":"D\u00f6pfner M, G\u00f6rtz\u2010Dorten A, Lehmkuhl G, Breuer D, Goletz H. DISYPS\u2010II. Diagnostik\u2010System f\u00fcr psychische St\u00f6rungen nach ICD\u201010 und DSM\u2010IV f\u00fcr Kinder und Jugendliche\u2010II. Bern: Verlag Hans\u2010Huber; 2008."},{"key":"e_1_3_1_26_2","volume-title":"DISYPS\u2010III. Diagnostik\u2010System f\u00fcr psychische St\u00f6rungen nach ICD\u201010 und DSM\u20105 f\u00fcr Kinder und Jugendliche\u2010III","author":"D\u00f6pfner M","year":"2017","unstructured":"D\u00f6pfner M, G\u00f6rtz\u2010Dorten A. DISYPS\u2010III. Diagnostik\u2010System f\u00fcr psychische St\u00f6rungen nach ICD\u201010 und DSM\u20105 f\u00fcr Kinder und Jugendliche\u2010III. Bern: Hogrefe Verlag; 2017."},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.105.5.1082"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezt062"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-017-1623-8"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.12.019"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002302"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2000.108952"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0486"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2022.10.022"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1080\/09297049.2017.1307952"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-2241"},{"key":"e_1_3_1_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyt261"},{"key":"e_1_3_1_38_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951122001469"},{"key":"e_1_3_1_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2005.07.051"},{"key":"e_1_3_1_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2025.02.013"},{"key":"e_1_3_1_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.04.059"},{"key":"e_1_3_1_42_2","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.1099283"},{"key":"e_1_3_1_43_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-309449"},{"key":"e_1_3_1_44_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.917507"},{"key":"e_1_3_1_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.865568"},{"key":"e_1_3_1_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2008.10.025"},{"key":"e_1_3_1_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013051"},{"key":"e_1_3_1_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.056305"},{"key":"e_1_3_1_49_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2015.4450"},{"key":"e_1_3_1_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009145"},{"key":"e_1_3_1_51_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.aac9396"},{"key":"e_1_3_1_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.09.824"},{"key":"e_1_3_1_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezad267"},{"key":"e_1_3_1_54_2","doi-asserted-by":"publisher","DOI":"10.1037\/0003-066X.54.1.5"},{"key":"e_1_3_1_55_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu299"},{"key":"e_1_3_1_56_2","doi-asserted-by":"publisher","DOI":"10.1080\/09297049.2022.2120191"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.043769","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T04:18:56Z","timestamp":1766117936000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.043769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":55,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2025,11,18]]}},"alternative-id":["10.1161\/JAHA.125.043769"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.043769","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]},"assertion":[{"value":"2025-05-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e043769"}}