A Randomized Clinical Trial Demonstrating Feasibility and Preliminary Efficacy of a Videoconference-Delivered Physical Activity Lifestyle Intervention Among Adolescents With a Congenital Heart Defect

Abstract Background Individuals with congenital heart defects are at increased risk for developing further cardiovascular complications, which can be mitigated by increasing physical activity. Given that positive health behaviors begin declining during older adolescence, it is vital to promote lifestyle changes in this population. Purpose The current study aims to (a) determine the feasibility/acceptability of the Congenital Heart Disease Physical Activity Lifestyle (CHD-PAL) intervention among adolescents (ages 15–18) with moderate and complex congenital heart defects, and (b) estimate the preliminary efficacy of CHD-PAL for increasing time spent in moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness and decreasing sedentary behavior. Methods Eligible participants were randomized into either CHD-PAL (eight 30-min videoconferencing sessions over 20 weeks with an interventionist + Fitbit + exercise prescription) or a comparator (Fitbit + exercise prescription). Results Sixty adolescents were randomized (76% recruitment rate; 94% of participants were retained from baseline to follow-up). Most adolescents (73%) and their parents/guardians (76%) reported that the trial was enjoyable. While there was no effect of arm on change in MVPA, sedentary behavior, or cardiorespiratory fitness for the entire sample, among those who engaged in <21 min of MVPA on average at baseline, adolescents in the CHD-PAL intervention had an increase of 16 min/day of MVPA more than comparators (d = 0.90). Conclusions The CHD-PAL intervention warrants examination in a larger trial to establish efficacy among those adolescents with a congenital heart defect who engage in <21 min of MVPA/day and should include follow-up assessments to examine effect durability. Clinical trials registration NCT03335475.

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Maternal Hypertension-Related Genotypes and Congenital Heart Defects

American Journal of Hypertension ◽

10.1093/ajh/hpaa116 ◽

2020 ◽

Author(s):

Yunping Lei ◽

Katherine L Ludorf ◽

Xiao Yu ◽

Renata H Benjamin ◽

Xue Gu ◽

...

Keyword(s):

Congenital Heart Defects ◽

Congenital Heart Defect ◽

Genetic Risk ◽

Congenital Heart ◽

Heart Defects ◽

Hispanic Women ◽

Genetic Risk Score ◽

Heart Defect ◽

Maternal Hypertension ◽

The Relationship

Abstract BACKGROUND Maternal hypertension has been associated with congenital heart defect occurrence in several studies. We assessed whether maternal genotypes associated with this condition were also associated with congenital heart defect occurrence. METHODS We used data from the National Birth Defects Prevention Study to identify non-Hispanic white (NHW) and Hispanic women with (cases) and without (controls) a pregnancy in which a select simple, isolated heart defect was present between 1999 and 2011. We genotyped 29 hypertension-related single nucleotide polymorphisms (SNPs). We conducted logistic regression analyses separately by race/ethnicity to assess the relationship between the presence of any congenital heart defect and each SNP and an overall blood pressure genetic risk score (GRS). All analyses were then repeated to assess 4 separate congenital heart defect subtypes. RESULTS Four hypertension-related variants were associated with congenital heart defects among NHW women (N = 1,568 with affected pregnancies). For example, 1 intronic variant in ARHGAP2, rs633185, was associated with conotruncal defects (odds ratio [OR]: 1.3, 95% confidence interval [CI]: 1.1–1.6). Additionally, 2 variants were associated with congenital heart defects among Hispanic women (N = 489 with affected pregnancies). The GRS had a significant association with septal defects (OR: 2.1, 95% CI: 1.2–3.5) among NHW women. CONCLUSIONS We replicated a previously reported association between rs633185 and conotruncal defects. Although additional hypertension-related SNPs were also associated with congenital heart defects, more work is needed to better understand the relationship between genetic risk for maternal hypertension and congenital heart defects occurrence.

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Hyperactivity and Inattention in Young Patients Born With an Atrial Septal or Ventricular Septal Defect

Frontiers in Pediatrics ◽

10.3389/fped.2021.786638 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sara Hirani Lau-Jensen ◽

Benjamin Asschenfeldt ◽

Lars Evald ◽

Vibeke E. Hjortdal

Keyword(s):

Congenital Heart Defects ◽

Congenital Heart Defect ◽

Adhd Symptom ◽

Congenital Heart ◽

Rating Scales ◽

Heart Defects ◽

Close Relative ◽

Adhd Symptoms ◽

Heart Defect ◽

Inattention And Hyperactivity

Background: Patients with congenital heart defects have a well-established risk of neuropsychiatric comorbidities. Inattention and hyperactivity are three to four times more frequent in children with complex congenital heart defects. We have previously shown a higher burden of overall attention deficit/hyperactivity disorder (ADHD) symptoms in adults with simple congenital heart defects as well. However, it is unknown whether the higher burden of ADHD symptoms is mainly driven by hyperactivity, inattention, or both.Methods: The participants [simple congenital heart defect = 80 (26.6 years old), controls = 36 (25.3 years old)] and a close relative for each (n = 107) responded to the long version of the Conners' Adults ADHD Rating Scales questionnaire. Our primary and secondary outcomes are mean T-scores in the ADHD scores and symptom sub-scores.Results: Patients with simple congenital heart defects reported a higher mean T-score at all three DSM-IV ADHD scores (ADHD—combined: 52.8 vs. 44.9, p = 0.007, ADHD—inattention: 55.5 vs. 46.4, p = 0.002, and ADHD—hyperactivity: 49.4 vs. 44.0, p = 0.03) and in all four ADHD symptom sub-scores (inattention/memory problems: 50.3 vs. 44.2, p = 0.001, hyperactivity/restlessness: 49.7 vs. 45.9, p = 0.03, impulsivity/emotional lability: 50.0 vs. 41.3, p = 0.001, and self-esteem problems: 53.8 vs. 46.3, p = 0.003). The results were maintained after the removal of outliers (incongruent responses), albeit the hyperactivity/restlessness ADHD symptom sub-score lost significance. Self- and informant ratings differed significantly on the ADHD—inattention score for the congenital heart defect group, where informants rated the ADHD—inattention scores better than the congenital heart defect patients rated themselves.Conclusions: Patients with a simple congenital heart defect have a higher symptom burden across all ADHD scores and all symptom sub-scores. The higher burden of ADHD is driven by both inattention and hyperactivity symptoms, though the inattention symptoms seem more prominent. Close relatives were less aware of the inattention symptoms than the congenital heart defect patients themselves. Routine screening for ADHD symptoms may be warranted to facilitate adequate help and guidance as these symptoms are easily overlooked.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03871881.

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Prevalence of Congenital Heart Defects in Neonates of Drug Abusing Mothers

international journal high risk behaviors & addiction ◽

10.5812/ijhrba.106884 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Mohammad Radgoodarzi ◽

Elahe Norouzi ◽

Zahra Vahedi ◽

Mitra Salavati ◽

Ameneh Yaghoubi ◽

...

Keyword(s):

Congenital Heart Defects ◽

Congenital Heart Defect ◽

Congenital Heart ◽

Heart Defects ◽

Normal Population ◽

Color Doppler ◽

Newborn Infants ◽

Teaching Hospitals ◽

Heart Defect ◽

Significant Difference

Background: Congenital heart defects (CHDs) are the most common congenital malformations at birth. Substance abuse has increased dramatically over the past two decades. It also can affect neonates of drug-abusing mothers. Objectives: This study aimed to elucidate the possible association of maternal drug abuse with CHDs in their newborn infants. Patients and Methods: In this study, 72 neonates who were born during 6 years in three teaching hospitals are studied. Echocardiography was performed by a single pediatric cardiologist using two-dimensional and color Doppler echocardiography. The data were analyzed using descriptive statistics. Results: 1) Of 72 included cases, 38 (52.78%) had abnormal echocardiographic findings; 2) from 38 abnormal echocardiography, 35 (48.61% of total and 92.11% of abnormal echoes) had mild congenital heart defect (CHD), and 3 had complex CHD; 3) There was no significant difference in the prevalence of neonatal congenital heart defect with the type of misused drugs (opiates or methamphetamines). Conclusions: In our study, the prevalence of CHD in newborns of drug abuser mothers was significantly higher than the normal population of infants. Hence, echocardiographic screening of these newborns seems to be logical.

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Physical activity in adolescents and adults with congenital heart defects: individualized exercise prescription

European Heart Journal ◽

10.1093/eurheartj/eht433 ◽

2013 ◽

Vol 34 (47) ◽

pp. 3669-3674 ◽

Cited By ~ 95

Author(s):

W. Budts ◽

M. Borjesson ◽

M. Chessa ◽

F. van Buuren ◽

P. Trigo Trindade ◽

...

Keyword(s):

Physical Activity ◽

Congenital Heart Defects ◽

Congenital Heart ◽

Exercise Prescription ◽

Heart Defects ◽

Adolescents And Adults

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Challenges of Diagnosing Congenital Heart Defects — Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

Russian Pediatric Journal ◽

10.15690/rpj.v2i1.2193 ◽

2021 ◽

Vol 2 (1) ◽

pp. 13-19

Author(s):

E. I. Naumenko ◽

I. A. Grishutkina ◽

E. S. Samoshkina

Keyword(s):

Coronary Artery ◽

Pulmonary Artery ◽

Congenital Heart Defects ◽

Congenital Heart Defect ◽

Congenital Heart ◽

Left Coronary Artery ◽

Heart Defects ◽

Anomalous Origin ◽

Anterior Axillary Line ◽

Heart Defect

Background. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) also known as Bland — White — Garland syndrome is a rare congenital heart defect that affects 1 in every 300 000 newborns, thus comprising 0.22% of all congenital heart defects and 0.4–0.7% of critical congenital heart defects. In case of a more favorable disease course, symptoms typically appear between the 1st and 2nd months after birth. The ECG may show typical signs of ischemia, myocardial infarction, and left ventricular hypertrophy. The EchoCG is more informative as it enables the visualization of coronary artery orifices. Surgical correction is the only treatment method for this heart defect.Case report. Patient G.S.V., one month of age, was admitted to the neonatal pathology unit. Based on the physical examination the patient’s condition was severe. The skin was pale with cyanosis of the nasolabial triangle. The respiration rate was accelerated (50–52 breaths per minute) with the indrawing of the intercostal spaces. The displacement of the apex beat 1 cm to the left of the left midclavicular line was revealed by palpation. The displacement of the left border of the relative cardiac dullness to the anterior axillary line was revealed by percussion. Upon auscultation, the first heart sound at the heart apex was decreased, and there was a blowing systolic murmur radiating to the left anterior axillary line. Upon examination the child was diagnosed with severe acute acquired non-rheumatic diffuse viral bacterial carditis. The lack of improvement in the child’s condition following the myocarditis treatment and the examination results were suggestive of the anomalous coronary artery. The child was transferred by emergency to the Penza Federal Center of Cardiovascular Surgery where the diagnosis was confirmed.Conclusion. Despite being rare, this congenital heart defect may be diagnosed in clinical pediatric practice. A thorough record of complaints and medical history is an important step in its early diagnosis, and the presence of signs of heart failure requires additional examination. In case of suspected myocardial lesions, presence of high troponin levels and other markers of myocardial injury in the blood, ECG signs of myocardial ischemia and lack of improvement despite the treatment conducted, pathologic changes in the coronary arteries must be ruled out.

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Cancer risk among patients with congenital heart defects: a nationwide follow-up study

Cardiology in the Young ◽

10.1017/s1047951112002144 ◽

2013 ◽

Vol 24 (1) ◽

pp. 40-46 ◽

Cited By ~ 14

Author(s):

Morten Olsen ◽

Ester Garne ◽

Claus Sværke ◽

Lars Søndergaard ◽

Henrik Nissen ◽

...

Keyword(s):

General Population ◽

Cancer Risk ◽

Confidence Interval ◽

Congenital Heart Defect ◽

Congenital Heart ◽

Heart Defects ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Heart Defect

AbstractObjectiveWe aimed to assess cancer risk in congenital heart defect patients, with and without Down's syndrome, compared with the general population.MethodsWe identified all patients born and diagnosed with congenital heart defects from 1977 to 2008 using the Danish National Registry of Patients, covering all Danish hospitals. We compared cancer incidence in the congenital heart defect cohort with that expected in the general population (∼5.5 million) using the Danish Cancer Registry, and computed age- and gender-standardised incidence ratios.ResultsWe identified 15,905 congenital heart defect patients, contributing a total of 151,172 person-years at risk; the maximum length of follow-up was 31 years (median 8 years). In all, 53 patients were diagnosed with cancer, including 30 female and 23 male patients (standardised incidence ratio = 1.63; 95% confidence interval: 1.22–2.13). Risks were increased for leukaemia, brain tumours, and basal cell carcinoma. After excluding 801 patients with Down's syndrome, the standardised incidence ratio was 1.19 (95% confidence interval: 0.84–1.64). In the subgroup of 5660 non-Down's syndrome patients undergoing cardiac surgery or catheter-based interventions, the standardised incidence ratio was 1.45 (95% confidence interval: 0.86–2.29).ConclusionThe overall risk of cancer among congenital heart defect patients without Down's syndrome was not statistically significantly elevated. Cancer risk in the congenital heart defect cohort as a whole, including patients with Down's syndrome, was increased compared with the general population, although the absolute risk was low. Studies with longer follow-up and more information on radiation doses are needed to further examine a potential cancer risk associated with diagnostic radiation exposure.

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In-Hospital Mortality for Surgical Repair of Congenital Heart Defects: Preliminary Observations of Variation by Hospital Caseload

PEDIATRICS ◽

10.1542/peds.95.3.323 ◽

1995 ◽

Vol 95 (3) ◽

pp. 323-330 ◽

Cited By ~ 10

Author(s):

Kathy J. Jenkins ◽

Jane W. Newburger ◽

James E. Lock ◽

Roger B. Davis ◽

Gerald A. Coffman ◽

...

Keyword(s):

Hospital Mortality ◽

Acute Care ◽

Congenital Heart Defects ◽

Congenital Heart Defect ◽

Congenital Heart ◽

Surgical Repair ◽

Heart Defects ◽

Hospital Charges ◽

Hospital Death ◽

Heart Defect

Objective. To examine the impact of hospital caseload on in-hospital mortality for pediatric congenital heart surgery. Design. Population-based, retrospective cohort study. Setting. Acute care hospitals in California and Massachusetts. Patients. Children undergoing surgery for congenital heart disease, identified by the presence of procedure codes indicating surgical repair of a congenital heart defect in computerized statewide hospital discharge abstract databases. Cases were grouped into four categories based on the complexity of the procedure. Main outcome measures. Adjusted odds ratios (OR) for in-hospital death were estimated using generalized estimating equations that account for the intra-institutional correlation among patients. Results. A total of 2833 cases at 37 centers were identified. Compared with centers performing >300 cases per year, after controlling for patient characteristics, centers performing <10 cases per year had an OR for in-hospital death of 7.7 (95% confidence interval (CI) [1.6-37.8]); 10 to 100 cases, OR = 2.9 (95% CI [1.6-5.3]); 101 to 300 cases, OR = 3.0 (95% CI [1.8-4.9]). Independent risk factors for mortality included procedure complexity category (P < .0001), use of cardiopulmonary bypass (P < .0001), young age at surgery (P = .001), and transfer from another acute care hospital (P < .0001). Few differences were found by hospital caseload in length of stay or total hospital charges. Conclusions. For children with a congenital heart defect who underwent surgery in California in 1988 or Massachusetts in 1989, the risk of dying in-hospital was much lower if the surgery was performed at an institution performing >300 cases annually. This study was limited by the absence of clinical detail in discharge abstract databases. If these findings are corroborated by other studies, health care delivery strategies that direct children requiring surgical correction of congenital heart defects to high-volume centers may substantially reduce overall mortality.

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Prenatal detection of congenital heart disease - results of a Swedish screening program 2013–2017

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04028-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maya Waern ◽

Mats Mellander ◽

Anton Berg ◽

Ylva Carlsson

Keyword(s):

Congenital Heart Defects ◽

Congenital Heart Defect ◽

Detection Rate ◽

Congenital Heart ◽

Screening Program ◽

Heart Defects ◽

Prenatal Detection ◽

Chamber View ◽

Heart Defect ◽

Prenatal Detection Rate

Abstract Background This report evaluates results of a screening program on prenatal detection of congenital heart defects in a geographical cohort of western Sweden between January 1st, 2013 and June 31st, 2017. During the study period 88,230 children were born in VGR. Methods Retrospective data on pregnant women from the Västra Götaland region that were referred to fetal cardiologists in Gothenburg were retrieved. To determine prenatal detection rate, all neonates who underwent surgery or catheter intervention for a critical congenital heart defect born between January 1st, 2014 and December 31st, 2016 were included. The four-chamber view was implemented into the routine scan in 2009 and implementation of the ISUOG guidelines, including the outflow tracts, started in the region in 2015. Results 113 fetuses received a prenatal diagnosis of a major congenital heart defect. 89% of these were referred because of a suspected cardiac malformation and 88% were diagnosed before 22 completed weeks. 59% of the patients diagnosed before 22 completed weeks opted for termination of pregnancy. During 2014–2016, 61 fetuses had a prenatal diagnosis of a critical congenital heart defect and a further 47 were diagnosed after birth, hence 56% were diagnosed prenatally, 82% for those which had a combination with an extracardiac abnormality and/or chromosomal aberration compared to 50% if an isolated critical congenital heart defect was diagnosed. For single ventricle cardiac defects such as hypoplastic left heart syndrome, double inlet left ventricle and tricuspid atresia, the detection rate was 100%. The detection rate for transposition of the great arteries and coarctation of the aorta was 9 and 18% respectively. Conclusions 56% of all fetuses with a critical congenital heart defect were diagnosed prenatally during 2014–2016 and approximately 53% of all major congenital heart defects 2013–2017 as compared to 13.8% in 2009 in the same region. An increased focus towards the fetal heart in the routine scan improved the prenatal detection rate of major congenital heart defects. The detection of congenital heart defects affecting the four-chamber view seems sufficient, but more training is needed to improve the quality of the examination of the outflow tracts.

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