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

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.

scholarly journals Maternal Hypertension-Related Genotypes and Congenital Heart Defects

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.

scholarly journals Prevalence of Congenital Heart Defects in Neonates of Drug Abusing Mothers

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.

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

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.

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

PEDIATRICS ◽  
1995 ◽  
Vol 95 (3) ◽  
pp. 323-330 ◽  
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.

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

2021 ◽  
Author(s):  
Jamie L Jackson ◽  
Kristen R Fox ◽  
Joseph R Rausch ◽  
Taylor N Swenski ◽  
Steven P Neville ◽  
...  
Keyword(s):  
Physical Activity ◽  
Sedentary Behavior ◽  
Cardiorespiratory Fitness ◽  
Congenital Heart Defects ◽  
Congenital Heart Defect ◽  
Congenital Heart ◽  
Exercise Prescription ◽  
Heart Defects ◽  
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.

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

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.

scholarly journals Oral corticosteroids during pregnancy and offspring risk of congenital heart defects: a nationwide cohort study

2019 ◽  
Vol 49 (2) ◽  
pp. 638-647
Author(s):  
Amalie Bøggild Schmidt ◽  
Marie Lund ◽  
Giulia Corn ◽  
Nina Øyen ◽  
Jan Wohlfahrt ◽  
...  
Keyword(s):  
Propensity Score ◽  
Confidence Interval ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Oral Corticosteroid ◽  
Heart Defects ◽  
Prevalence Ratio ◽  
Heart Defect ◽  
Causal Pathway ◽  
Oral Corticosteroids

Abstract Background Pre-pregnancy diabetes is a strong risk factor for congenital heart defects (CHDs), suggesting a role for glucose in the causal pathway. Oral corticosteroids may cause hyperglycemia and maternal use could affect embryonic heart development. The objective of this study was to determine the association between maternal intake of oral corticosteroids 0–8 weeks after conception and CHDs in offspring. Methods A register-based nationwide prevalence study including all live singleton births in Denmark, 1996–2016, was conducted. In total, 1 194 687 individuals and their mothers were identified and linked with information on offspring CHDs and the mothers’ use of oral corticosteroids in early pregnancy. Corticosteroid use was defined as a filled prescription for maternal use of oral corticosteroid 0–8 weeks after conception. CHDs were identified through International Classification of Diseases codes. The association was estimated by prevalence (odds) ratios using logistic regression and propensity score-matched analyses. Results Among 1 194 687 live births, 2032 had a mother who had used oral corticosteroids 0–8 weeks from conception. Of these offspring, 32 had a heart defect. Among the offspring of never-users of oral corticosteroids, 10 534 had a heart defect. The adjusted prevalence ratio was 1.29 (95% confidence interval, 0.90–1.84) comparing offspring prevalence of heart defects in oral corticosteroid users with that in oral corticosteroid never-users. Propensity score-matched analysis yielded similar results (prevalence ratio 1.38; 95% confidence interval, 0.95–2.02). Conclusions This study supports that there is no association between maternal use of oral corticosteroids in the first 8 weeks after conception and CHDs.

scholarly journals Ebstejn's anomaly in patients perioperative period during a non-cardiac surgery operation

Praxis medica ◽  
2020 ◽  
Vol 49 (3-4) ◽  
pp. 55-59
Author(s):  
Ljubiša Mirić ◽  
Tijana Smiljković ◽  
Vladan Perić ◽  
Slađana Mirić ◽  
Tjaša Ivošević
Keyword(s):  
Congenital Heart Defect ◽  
Congenital Heart ◽  
Heart Defects ◽  
Clinical Status ◽  
Perioperative Period ◽  
Gas Analysis ◽  
Ebstein Anomaly ◽  
Functional Abnormality ◽  
Heart Defect ◽  
The Right

Introduction: Ebstein anomaly, a congenital heart defect characterized by a morphological and functional abnormality of the tricuspid valvula while moving the mouth of the tricuspid valvula towards the apex of the right chamber. Case report: A patient aged 39 years on the Department of Surgery was admitted under the image of an acute abdomen and the need for emergency surgical treatment. Routine preoperative preparation, laboratory treatment, examination of internist and examination of anesthesiologist on the part of the part was carried out. He has a history of occasional breathing problems during respiratory infection, a smoker. Clinical status, other than primary problems, is orderly. Operational treatment passed neatly, on the fourth postoperative day the patient complained of suffocation, lack of air and chest pain, translated into intensive care monitored (spo2 87% f about 110/min TA 90/60), blood gas analysis done and laboratory treatment (fibrinogen, D dimer) due to suspected pulmonary thromboembolia consulted cardiologist, dilation of the right atrium seen by ultrasound. Discussion: Non-cardiac surgeries in patients with pre-existing congenital heart defects are high-risk surgeries with increased mobility and mortality in the perioperative period. In accordance with the accompanying pathoanatomical and pathophysiological changes that define the congenital heart defect, a detailed plan must be made - anesthesiological management for each patient separately. Hemodynamic and respiratory stability with avoidance of hypoxia and paradoxical arrhythmias are the basic postulates in patients with Ebstein's anomaly.

scholarly journals The fitness cost of a congenital heart defect shapes its genetic architecture

2019 ◽  
Author(s):  
Ehiole Akhirome ◽  
Suk D. Regmi ◽  
Rachel A. Magnan ◽  
Nelson Ugwu ◽  
Yidan Qin ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart Defect ◽  
Genetic Architecture ◽  
Congenital Heart ◽  
Septal Defect ◽  
Heart Defects ◽  
Atrioventricular Septal Defect ◽  
Fitness Cost ◽  
Heart Defect

ABSTRACTBackgroundIn newborns, severe congenital heart defects are rarer than mild ones. The reason why is unknown, but presumably related to a liability threshold that rises with the severity of a defect. Because the same genetic mutation can cause different defects, other variables may contribute to pushing an individual past a defect-specific liability threshold. We consider here how variables in the genetic architecture of a heart defect depend upon its fitness cost, as defined by the likelihood of survival to reproductive age in natural history studies.MethodsWe phenotyped ~10,000 Nkx2-5+/- newborn mice, a model of human congenital heart disease, from two inbred strain crosses. Genome-wide association analyses detected loci that modify the risk of an atrial septal defect, membranous or muscular ventricular septal defect, or atrioventricular septal defect. The number of loci, heritability and quantitative effects on risk of pairwise (G×GNkx) and higher-order (G×G×GNkx) epistasis between the loci and Nkx2-5 mutation were examined as a function of the fitness cost of a defect.ResultsNkx2-5+/- mice have pleiotropic heart defects; about 70% have normal hearts. The model recapitulates the epidemiological relationship between the severity and incidence of a heart defect. Neither the number of modifier loci nor heritability depends upon the severity of a defect, but G×GNkx and G×G×GNkx effects on risk do. Interestingly, G×G×GNkx effects are three times more likely to suppress risk when the genotypes at the first two loci are homozygous and from the same, rather than opposite strains in a cross. Syn- and anti-homozygous genotypes at G×G×GNkx interactions can have an especially large impact on the risk of an atrioventricular septal defect.ConclusionsGiven a modestly penetrant mutation, epistasis contributes more to the risk of severe than mild congenital heart defect. Conversely, genetic compatibility between interacting genes, as indicated by the protective effects of syn-homozygosity at G×G×GNkx interactions, plays a newfound role in the robustness of cardiac development. The experimental model offers practical insights into the nature of genetic risk in congenital heart disease. The results more fundamentally address a longstanding question regarding how mutational robustness could arise from natural selection.

Sign in / Sign up

Export Citation Format

Share Document