Author ORCID Identifier

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Tricia Z. King

Second Advisor

Vince Calhoun

Third Advisor

Kristen Hoskinson

Fourth Advisor

Ashley Ware


Congenital heart defects are one of the most prevalent birth defects in the world, with the structural changes to the heart impacting oxygen capacity and brain development. Altered brain development and increased acquired brain injury risk from surgery (e.g., reduced brain volume, white matter injury, hemorrhage) put individuals with congenital heart disease (CHD) at increased risk of poor neurocognitive outcomes. Examining brain networks via graph theory analysis and how they relate to cognitive outcomes allows for an increased understanding of brain-behavior relationships in this at-risk population. To date, research utilizing graph theory in this population has been limited to one CHD diagnosis within a restricted age range. The current study examines how the structural connectome relates to cognitive outcomes in early to late adolescents with mixed CHD diagnoses. Thirty-seven participants with CHD and 38 healthy age-and gender-matched peers underwent neuroimaging and completed cognitive measures (processing speed, intelligence, informant-reported executive functioning). Analyses investigated group differences in global network metrics and relationships among five global network metrics and performance on select cognitive measures. Individuals with single-ventricle CHD, the group with the most severe disease types, showed significantly lower small-worldness compared to double-ventricle CHD and healthy peers with a large effect size (��2=.15). Moderate correlations were observed between network metrics and cognitive measures, but they did not survive correction for multiple comparisons. In conclusion, small-worldness most robustly differed between groups, with single-ventricle CHD showing the lowest small-worldness values. While correlational relationships did not survive multiple comparisons, they provide preliminary evidence to guide future research on brain-behavior relationships in CHD. Larger multi-site studies are required to allow for further investigation of these potentially subtle differences between CHD severity groups.


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Available for download on Wednesday, July 02, 2025