Neurodevelopmental outcome in children with congenital heart disease

Martinez‐Biarge, Miriam; Jowett, Victoria; Cowan, Frances; Wusthoff, Courtney J.

doi:10.1016/j.siny.2013.04.006

Cited by 50 publications

(30 citation statements)

References 55 publications

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“…Our findings extend the knowledge of long-term neurological impairment and mental health functional morbidities in the population with CHD. Although previous studies have reported elevated risks of adverse neurodevelopmental outcomes among individuals with CHD, including increased occurrence of depression, autism, and epilepsy compared with the general population, [6][7][8]19,[32][33][34][35] our study examined an older adult population to determine the later-life consequences of this neurological outcome. Although the underlying pathophysiological mechanisms are not completely understood, the potential etiologic factors appear multifactorial and consistent with previous findings within the neurodevelopmental scientific literature.…”

Section: Discussionmentioning

confidence: 99%

“…7,32,33 For example, vascular brain injuries, including clinically silent strokes, have been observed both pre-and postoperatively in infants with CHD. 6 Hypoxemia affects the same cellular pathways and may enhance this effect. 6,19,39,41 In our study, the relative risk of dementia was increased among adults with severe CHD, as well as among lesions with a cyanotic potential.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Neurodevelopmental deficits among infants and children with CHD are well described. [6][7][8] However, research on long-term neurological outcomes in adults with CHD is more limited. Dementia is among the most important late-life neurological diseases in the general population.…”

mentioning

confidence: 99%

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Risk of Dementia in Adults With Congenital Heart Disease

Bagge¹,

Henderson

Laursen³

et al. 2018

Circulation

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Editorial, see p XXXBACKGROUND: More children with congenital heart disease (CHD) are surviving to adulthood, and CHD is associated with risk factors for dementia. We compared the risk of dementia in CHD adults to that of the general population. METHODS:In this cohort study, we used medical registries and a medical record review covering all Danish hospitals to identify adults with CHD diagnosed between 1963 and 2012. These individuals with CHD were followed from January 1, 1981, 30 years of age, or date of first CHD registration (index date for matched members of the general population cohort) until hospital diagnosis of dementia, death, emigration, or end of study (December 31, 2012). For each individual with CHD, we identified 10 members of the general population utilizing the Danish Civil Registration System matched on sex and birth year. We computed cumulative incidences and hazard ratios (HRs) of dementia, adjusting for sex and birth year. RESULTS:The cumulative incidence of dementia was 4% by 80 years of age in 10 632 adults with CHD (46% male). The overall HR comparing adults with CHD with the general population cohort was 1.6 (95% confidence interval [CI], 1.3−2.0). The HR among individuals with CHD without extracardiac defects was 1.4 (95% CI, 1.1−1.8). Adults with mild-to-moderate CHD had an HR of 1.5 (95% CI, 1.1−2.0), whereas the HR was 2.0 (95% CI, 1.2−3.3) for severe CHD, including univentricular hearts. The HR for early onset dementia (<65 years of age) was 2.6 (95% CI, 1.8−3.8), whereas the late-onset HR was 1.3 (95% CI, 1.0−1.8).CONCLUSIONS: CHD was associated with an increased risk of dementia compared with the general population, in particular for early onset dementia. Further understanding of dementia risk in the population with CHD is a potential target for future investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk of Dementia in Adults With Congenital Heart Disease

Bagge¹,

Henderson

Laursen³

et al. 2018

Circulation

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“…Data on cognitive function in ACHD are limited and mixed [19], but a predilection toward neurologic abnormalities in ACHD can be expected given the high frequency of neurodevelopmental abnormalities in pediatric CHD [20]. The prevalence of neurologic abnormalities among school-age CHD patients ranges from 20% in total anomalous pulmonary venous connection and isolated atrioventricular septal defects, to as high as 70% in TGA and hypoplastic left heart syndrome [21]. In general, the prevalence and severity of neurodevelopmental impairment increase with lesion complexity [22].…”

Section: Neurodevelopmental Issuesmentioning

confidence: 99%

“…Relative anemia, therefore, occurs at much higher hemoglobin levels than in the general population, and often goes unnoticed. Using a definition for anemia corrected for baseline hypoxemia, 61% of CCHD patients are affected [21].…”

Section: Hematologic Consequences Of Cchdmentioning

confidence: 99%

Extra-cardiac manifestations of adult congenital heart disease

Gaeta

Ward

Krasuski

2016

Trends in Cardiovascular Medicine

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a b s t r a c tAdvancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities. In this review, we outline the current understanding and recent research into these extra-cardiac manifestations.Key words: Cardiovascular disease, Adult congenital heart disease, Pulmonary hypertension. Advances in the diagnosis and management of congenital heart disease (CHD) over the past several decades have greatly improved longevity and quality of life in the CHD population. Palliative or corrective interventions are now available for nearly every type of congenital cardiac lesion, and approximately 90% of affected children now survive to adulthood [1]. Adults with CHD (ACHD) already outnumber pediatric CHD patients, and this population is expected to grow by 5% per year [1,2]. Strikingly, the median age of severe CHD patients has increased from 11 years in 1985 to 25 years in 2010 [3]. Continued improvement in CHD interventions means that new (and more complex) populations will likely reach adulthood in the coming years.Practitioners who take care of adults with CHD are often charged with the delivery or coordination of comprehensive care for these complex patients, including the management of manifestations and complications that arise later in life. ACHD has many extra-cardiac effects, both as syndromic associations with congenital heart defects, or more commonly, as sequelae of primary structural or hemodynamic abnormalities. The role of genetic predilection remains undefined for nearly all extra-cardiac complications, though their incidence has clearly risen over the past decades. Indeed, more than a third of hospital admissions for ACHD patients are now for noncardiovascular reasons [4]. Optimal care of ACHD patients, therefore, mandates a thorough understanding of its multiorgan system manifestations. Herein, we will review current understanding of the most common manifestations of ACHD organized by the affected organ systems. Neurologic/neuropsychiatric Cerebrovascular complicationsA recent study quantified the strikingly high rates of stroke in ACHD [5]. Among nearly 30,000 ACHD patients, 8.9% of men http://dx

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