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Landzberg MJ, Murphy DJ, Davidson WR, Jarcho JA, Krumholz HM, Mayer JE, Mee RB, Sahn DJ, Van Hare GF, Webb GD, Williams RG. Task force 4: organization of delivery systems for adults with congenital heart disease. J Am Coll Cardiol 2001; 37:1187-93. [PMID: 11300421 DOI: 10.1016/s0735-1097(01)01275-x] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Warnes CA, Liberthson R, Danielson GK, Dore A, Harris L, Hoffman JI, Somerville J, Williams RG, Webb GD. Task force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001; 37:1170-5. [PMID: 11300418 DOI: 10.1016/s0735-1097(01)01272-4] [Citation(s) in RCA: 970] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Foster E, Graham TP, Driscoll DJ, Reid GJ, Reiss JG, Russell IA, Sermer M, Siu SC, Uzark K, Williams RG, Webb GD. Task force 2: special health care needs of adults with congenital heart disease. J Am Coll Cardiol 2001; 37:1176-83. [PMID: 11300419 DOI: 10.1016/s0735-1097(01)01277-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Oechslin E, Hoffmann A. [Organizational and medical aspects of transition of juveniles with congenital heart defects to adult cardiology care]. THERAPEUTISCHE UMSCHAU 2001; 58:111-8. [PMID: 11234451 DOI: 10.1024/0040-5930.58.2.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A growing, heterogeneous group of children with congenital heart disease is surviving into adulthood due to advances in medicine. These patients including those with simple and complex congenital heart disease and operated on during childhood are facing long-term complications. Superspecialist care and expertise are required during their life to deal with their unique problems the most common being ventricular failure, arrhythmias, valve and conduit longevity. Teenagers and adolescents disappear from both medical and parental care because of the lack of transition programs. Transition of care from pediatric to adult cardiologists must be organized in each country and must reflect regional history, regional politics and realities. Transition of care requires goodwill from parents, adolescents, pediatric and adult cardiologists. Transition clinics being held jointly by pediatric and adult cardiologists between the age of 16 and 18 years are essential to encourage the adolescents to take charge of their own life and health issues. Adequate information about their heart defect, their operations and their residual lesions may help them understand the implications for the future and improve their compliance. A transition program must include counseling on education, career, endocarditis prophylaxis, insurance and lifestyle issues such as sexuality and reproduction (including anticonception, pregnancy), cardiovascular risk factors and sports activities. Medical reports including operative reports and heart catheterization reports must be transferred to the adult cardiologists. In Switzerland, care of adults with congenital heart disease is based on three levels: 1) primary caregivers including general practiioners, internists and community cardiologists; 2) cardiologists with special commitment and expertise to patients with congenital heart disease who organize regional outpatient clinics; 3) supraregional referral centers with cardiologists trained in pediatric and adult congenital heart disease and experienced in the special needs, problems and management of this unique population. A close collaboration between pediatric and adult cardiologists participating jointly in the care of congenital heart disease patients is very important. An interdisciplinary team offers all non-invasive and invasive facilities for diagnostic and therapeutic procedures in a supraregional referral center. A close collaboration among all physicians is crucial for optimal care and management. Integration of adolescents with congenital heart disease into an adult medical system improves both compliance and quality of care and supports the patient's esteem because many medical aspects and lifestyle issues are completely different from those during childhood.
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Abadie V, Wiener-Vacher S, Morisseau-Durand MP, Porée C, Amiel J, Amanou L, Peigné C, Lyonnet S, Manac'h Y. Vestibular anomalies in CHARGE syndrome: investigations on and consequences for postural development. Eur J Pediatr 2000; 159:569-74. [PMID: 10968232 DOI: 10.1007/s004319900409] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Recently, vestibular anomalies have been described as a frequent feature in children with coloboma-heart-atresia-retarded-genital-ear (CHARGE) syndrome. They are likely to play an important role in the psychomotor retardation affecting these children. In order to test this hypothesis, we prospectively performed complete vestibular investigations in a series of 17 CHARGE syndrome patients including inner ear CT scan and functional vestibular evaluation of both canal and otolith functions. These results were correlated with the postural anomalies observed during the children's development and showed that vestibular dysfunction is a constant feature in CHARGE syndrome and has very good sensitivity for confirming the diagnosis. Anomalies of semicircular canals were frequently found (94%), easily detectable on CT scan and associated with no response on canal function evaluation. They were considered as partly responsible for the retardation of postural stages. Vestibular functional tests were consistently abnormal but allowed detection of residual otolith function in most patients (94%). All children of this series had an atypical pattern of postural behaviour that we consider to be related to their vestibular anomalies. Residual otolith function seems to have a positive influence for postural development. CONCLUSION Vestibular investigations are valuable for diagnosis, developmental assessment, and adaptation of specific rehabilitation programmes in CHARGE syndrome patients.
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Abstract
OBJECTIVE To determine if appropriate advice had been given to adults with congenital heart disease regarding safe and effective exercise, and to assess pre-existing misconceptions of the potential benefits and dangers of exercise. DESIGN An anonymous self assessment questionnaire. SETTING A tertiary referral clinic. PATIENTS 99 adults (57 men, 42 women) with congenital heart disease, mean age 25.6 years. MAIN OUTCOME MEASURES The extent and nature of exercise advice given over previous years; a measure of current activity level compared with the American Heart Association recommendations; and an assessment of exercise limiting symptoms and a description of barriers to further exercise. RESULTS 44% of the cohort assumed all exercise was safe despite their cardiac disease. A health care professional had only raised the issue of specific exercise advice in 28 cases. Of those given instruction it was more common to receive prohibitive advice (30%) than to be encouraged to take more exercise (19%). Despite this 61% were involved in some form of at least light exercise. The most prevalent barriers to exercise were current symptoms (32.3%), lack of interest in exercise (24.2%), and health fears (16.1%). CONCLUSIONS The education of adults with congenital heart disease regarding exercise and its potential benefits and limitations is suboptimal even in a specialist clinic.
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Buheitel G, Hofbeck M, Gerling S, Koch A, Singer H. Similarities and differences in the exercise performance of patients after a modified Fontan procedure compared to patients with complete transposition following a Senning operation. Cardiol Young 2000; 10:201-7. [PMID: 10824899 DOI: 10.1017/s1047951100009112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate cardiopulmonary performance in patients after a Fontan procedure, comparing it to patients following a Senning operation. METHODS We studied 21 children, with a mean age of 11.1 years, after a total cavopulmonary anastomosis, comparing them to 13 with complete transposition after a Senning procedure, having a mean age of 11.8 years, and 21 control subjects with a mean age of 11.2 years. All were tested on a bicycle ergospirometer. RESULTS Peak consumption of oxygen, maximal work rate, peak oxygen pulse and endexpiratory pressure of carbon dioxide at a work rate of 1.5 Watt/kg were lowest in patients with a modified Fontan procedure, and highest in the control group (p < or = 0.0278). Production of carbon dioxide, and minute ventilation at a work rate of 1.5 Watt/kg, was highest in the patients after Fontan procedure, and lowest in the healthy subjects (p < or = 0.0163). Production of carbon dioxide per single breath was lower in those having a Fontan procedure (28.9 ml) than in the two other groups (35.1 ml; p = 0.0243). The tidal volume showed no significant differences between the three groups. CONCLUSIONS The reaction to exercise was identical qualitatively in both groups of patients, and comparable to the behaviour of patients with chronic heart failure. Quantitatively, the results of the patients following a Senning procedure lay between those of control subjects and those who had undergone a Fontan operation. The only exception was dead space ventilation, where the patients after a Fontan procedure differed from the two other groups because of their increased ventilation-perfusion mismatch.
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Fredriksen PM, Kahrs N, Blaasvaer S, Sigurdsen E, Gundersen O, Roeksund O, Norgaand G, Vik JT, Soerbye O, Ingjer E, Thaulow E. Effect of physical training in children and adolescents with congenital heart disease. Cardiol Young 2000; 10:107-14. [PMID: 10817293 DOI: 10.1017/s1047951100006557] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In order to test the effect of systematic supervised physical training, we divided a total of 129 children and adolescents with congenital heart disease into a group undergoing intervention and a control group. All patients underwent exercise tests, measurements of physical activity, and a survey of psychosocial factors. An improvement in uptake of peak level of oxygen was observed after intervention. There was also an improvement in physical activity in both groups measured by a monitor, although this was significant only in those with intervention. The psychosocial scales measured by the Child Behavior Checklist showed a decrease in internalizing scores for those subjected to intervention. This was decreased due to decreased withdrawal and somatic complaints. In conclusion, we recommend systematic supervised training, including testing of routine follow-ups, in patients with congenital heart disease.
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Bar-Mor G, Zeevi B, Yaaron M, Falk B. Use of the heart rate monitor to modulate physical activity in adolescents with congenital aortic stenosis: an innovative approach. J Pediatr Nurs 1999; 14:273-7. [PMID: 10467807 DOI: 10.1016/s0882-5963(99)80026-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The task of setting exercise limitations on children with aortic stenosis is fraught with difficulties. In particular, teenagers are difficult to manage because of the increasingly professional demands of adolescents sports; the rapid changes in somatic growth, which are often accompanied by an increase in the severity of aortic valve disease; and the natural tendency of teenagers to disregard advice from authoritarian sources like a medical team. This article describes our innovative approach of using a heart-rate monitor as a means of modulating physical activity in adolescents with mild to moderate aortic stenosis. This approach enabled the setting of clear, precise, observable, measureable limits on physical activity, and self-controling of an acceptable level of physical activity. This created a different negotiation between the patient, his parents, and the medical team, and eased the concern and anxiety of the mothers.
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Knight DR, Franklin WH, Cohen DM, Davis JT, Shiels W, Long F, Allen HD. Case studies of cycle exercise early after cardiothoracic surgery. JOURNAL OF CARDIOPULMONARY REHABILITATION 1999; 19:186-9. [PMID: 10361650 DOI: 10.1097/00008483-199905000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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61
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Abstract
Exercise testing is an exceedingly useful noninvasive method for assessing cardiovascular function not only at rest but also during programmed, supervised physical exercise. Exercise testing has been intensively studied to delineate the cardiovascular response in various disorders [3-5, 15, 19, 22, 23, 26, 32]. Exercise testing as a tool for rehabilitation and for training to perform physical activity is discussed here.
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Shumway SJ. Heart transplantation in the pediatric age-group and for end-stage congenital heart defects. Mayo Clin Proc 1998; 73:1025-6. [PMID: 9787755 DOI: 10.4065/73.10.1025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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63
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Immer FF, Seiler AM, Stocker F. [Status and after-care of young adults with congenital heart defects]. SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT 1998; 128:1012-9. [PMID: 9691336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION We studied patients with congenital heart defects born in 1975 and followed by our institution. We were interested in the outcome of these patients at the age of 20 years with regard to professional status, physical activity and psychosocial aspects. Furthermore, we investigated the handover from the paediatric to the adult cardiologist as well as the information level concerning antibiotic prophylaxis against bacterial endocarditis. METHODS From a previous follow-up study to the age of 16 years, we knew 224 patients with congenital heart disease born in 1975, 119 were considered to need further cardiological follow-up. In 112 (94%) we have a complete follow-up to the age of 20 years with a structured interview by phone. RESULTS Mortality and medical care during the period between 16 and 20 years of age were at a lower level than in the previous periods. Except in patients suffering from complex or surgically treated cyanotic heart disease, the results, compared to the standard population at the age of 20 years, are better with regard to professional status, and equal for physical activity and psychosocial integration. Only 60% of the patients were followed by an adult cardiologist and only 45% of the patients needing antibiotic prophylaxis against bacterial endocarditis are aware of this. CONCLUSION Except in patients with complex congenital or surgically treated cyanotic heart diseases, the outcome at the age of 20 years with regard to professional status, physical activity and psychosocial integration is very good compared with the standard population at the age of 20 years. The handover to the adult cardiologist is inadequate and knowledge and awareness of antibiotic prophylaxis against bacterial endocarditis is also insufficient-both aspects need improvement.
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64
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Calzolari A, Pastore E, Biondi G. [Cardiac rehabilitation in children. Interdisciplinary approach]. Minerva Pediatr 1997; 49:559-65. [PMID: 9577157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The concept of rehabilitation has been defined by the authors as a supervised process of progressive exercise training to improve aerobic fitness. Cardiac rehabilitation in children should be dedicated to patients with repaired complex congenital heart diseases who have residual functional and psychological problems. The basic objectives for rehabilitation are defined: to improve exercise efficiency, aerobic capacity and quality of life, to reduce the incidence of sudden death, to enable young patients to take part safely and effectively in athletics. The guidelines for organising a cardiac rehabilitation programme are specified. First of all the need of protected environments, functional evaluation before starting the programme, the description of the rehabilitation session and staff needed. Equally important is the psychosocial aspect. It is difficult to quantify, in a scientific manner, the effectiveness of psychosocial intervention, but it helps the children to integrate into social life thus enhancing their quality of life. The results of a census of 110 world-wide centres offering regular cardiac rehabilitation programmes are presented. Italy currently has only two centres suitable for pediatric cardiac rehabilitation: they treat a small number of patients. Personal experience, with 20 patients, agrees with that of Galioto, about an increase in exercise capacity of these patients after rehabilitation programme, with an increased cardiac output at rest and at peak of exercise, an increased O2 uptake and an increased duration of exercise testing. The usefulness of cardiac rehabilitation programmes, the need of interdisciplinary approach and increasing the case series are stressed.
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65
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Sparacino PS, Tong EM, Messias DK, Foote D, Chesla CA, Gilliss CL. The dilemmas of parents of adolescents and young adults with congenital heart disease. Heart Lung 1997; 26:187-95. [PMID: 9176686 DOI: 10.1016/s0147-9563(97)90055-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To provide a better understanding of parents' experiences as their children with congenital heart disease mature through adolescence and young adulthood. DESIGN A qualitative pilot study. SETTING The physician practices of the pediatric cardiology service of a large university medical center. SUBJECTS Eight parents of adolescents and young adults with congenital heart disease. INTERVENTION Each parent was separately interviewed with use of a semistructured interview guide. RESULTS Our study has identified seven themes--the dilemmas of normality, disclosure dilemmas, the challenge of uncertainty, illness management dilemmas and strategies, social integration versus social isolation, the impact of illness on the family, and coping--with which parents have struggled through-out their adolescent's and young adult's life. It was not possible to determine whether the experiences described by these parents are unique. CONCLUSIONS Parents experience distress, as outlined in the seven themes. They need assistance to determine what is "normal" for their child and how to monitor their child's health and safety. Further research is needed to develop specific interventions.
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66
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Volkov VS, Shchegol'kov AM, Kliachkin LM, Skiba AB, Kosov VA. [Hyperbaric oxygenation in the combined sanatorium rehabilitation of patients with corrected heart defects]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 1997:13-4. [PMID: 9254494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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67
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Gritsenko VV, Likhnitskaia II, Mochalov OI, Miroshkina VM. [The medical aspects of the rehabilitation of patients with congenital heart defects and the problems of their social integration into modern society]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 1997; 156:11-6. [PMID: 9235748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Treatment of 500 patients was used as a basis for the development of a complex stepwise programme of rehabilitation of patients with congenital heart diseases (CHD). It was noted that for a valuable social integration of people with CHD into the modern society it was necessary to perform not only the indicated, adequate and timely operations but also the inescapable measures for the improvement of their physical and psychophysiological adaptation. The following job in remote periods of observations of the patients operated upon must take into account its conformity to functional possibilities of energy expenditure for the chosen occupation and should be effected with the individually accessible (or indicated) level of the physical tension taken into consideration.
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68
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Tan LL, Huang JF, Wang H. [The effect of rehabilitation training on postoperative recovery of children with congenital heart disease]. ZHONGHUA HU LI ZA ZHI = CHINESE JOURNAL OF NURSING 1996; 31:314-5. [PMID: 8945145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this study, seven stages rehabilitation exercise were set up according to the rehabilitation training principles. 83 post-operative congenital heart disease children whose age ranging from 4 approximately 12 years were divided into two groups. The results showed that there was a significant difference between rehabilitation training group and control group in the time of ventilator weaning, intensive care, and mean hospitalization. The time of ventilator wearing was 7.34 hours shorter in the study group than that of control group. The time of under intensive care and hospitalization were also 2.04 days and 3.24 days shorter respectively. It is suggested that rehabilitation training has a good effect on post-operative children with congenital heart disease.
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69
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Fiane AE, Lindberg HL, Saatvedt K, Svennevig JL. Mechanical valve replacement in congenital heart disease. THE JOURNAL OF HEART VALVE DISEASE 1996; 5:337-42. [PMID: 8793687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS OF THE STUDY Mechanical valves are the prosthesis of choice in valve replacement in children. However, the problem of somatic growth leading to patient-valve mismatch remains present, and the appropriate anticoagulation regimen remains controversial. We present our experience of valve replacement in a young population over 20 years. MATERIALS AND METHODS Between 1972 and 1992, 48 patients (34 males and 14 females), mean age 11.2 years (range 0.4-27.4 years), underwent mechanical valve replacement at our institution. Aortic valve replacement was performed in 28 patients (58.3%), mitral valve replacement in 13 (27.1%), tricuspid valve replacement in six (12.5%) and pulmonary valve replacement in one patient (2.1%). The prostheses used were: St. Jude Medical (n = 2), Björk-Shiley (n = 14), Medtronic Hall (n = 16), Duromedics (n = 2) and CarboMedics (n = 14). Early mortality was 14.3%, 10.7% for aortic valve replacement and 30.8% for mitral valve replacement. Mean follow up for all patients was 8.3 years (range 0-22 years), with a total of 398 patient-years. RESULTS Seven patients died during the follow up (17.1%). Survival after 10 years, including operative mortality, was 81% for aortic valve replacement, 33% for mitral valve replacement, 83% for tricuspid valve replacement and 100% for pulmonary valve replacement. All patients were anticoagulated with warfarin. In eight patients (16.7%) an antiplatelet drug (aspirin or dipyridamole) was added. Major events included paravalvular leak in six patients (1.5%/pty), valve thrombosis in five (mitral position in two, tricuspid in three) (1.3%/pty) and endocarditis in one patient (0.3%/pty). Minor thromboembolic events occurred in three patients (0.8%/pty) and minor hemorrhagic events in three (0.8%/pty). No patients developed hemolytic anemia and there was no case of structural failure. CONCLUSIONS In our experience, mechanical prostheses in congenital heart disease were associated with significant morbidity and mortality, however long term survival after aortic valve replacement was good (81% at 10 years). Thromboembolic and hemorrhagic events were of minor significance. Atrio-ventricular valve replacement carried the highest risk of valve thrombosis and we now give warfarin and an antiplatelet drug to children undergoing mechanical valve implantation in this position.
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70
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Wang H, Huang JF, Ji N. [The effect of adaptive behavior training on rehabilitation of children with congenital heart disease]. ZHONGHUA HU LI ZA ZHI = CHINESE JOURNAL OF NURSING 1996; 31:190-2. [PMID: 8826204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The adaptation behaviors of 102 children with congenital heart disease were assessed by Children's Adaptation Behaviors Scale. The result indicated that behavior training should be given according to their adaptive behaviors before operation. 106 children with congenital heart disease were divided into two groups. 67 were in behavior training group and 39 were in control group. The result showed that self-care abilities and compliance of therapeutic regimen of the training group were much better than that of the control group. The length of stay in the hospital of the training group was 3.01 days shorter than that of the control group.
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71
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Tomassoni TL. Role of exercise in the management of cardiovascular disease in children and youth. Med Sci Sports Exerc 1996; 28:406-13. [PMID: 8778544 DOI: 10.1097/00005768-199604000-00003] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Most cardiovascular disease in children and youth is the result of congenital anomalies. Surgical techniques for repair of these defects have improved greatly since they were first developed, and a high percentage of patients become healthy, active adults. Less frequently, other types of cardiovascular disease may be acquired sometime after birth. In patients with either congenital or acquired heart disease, there is often some degree of exercise limitation. Appropriately, there is an increasing interest in the use of exercise testing and training in the clinical management of both congenital and acquired cardiovascular disease in children and youth. This review describes the exercise responses of patients with various forms of cardiovascular disease and discusses the use of exercise training to improve the well-being of these children and adolescents.
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72
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Mühler EG, Franke A, Lepper W, Grabitz RG, Herrmann G, Klues HG, Messmer BJ, Hanrath P, von Bernuth G. [The management of adolescents and adults with congenital heart defects: 3 years experiences with interdisciplinary consultation]. ZEITSCHRIFT FUR KARDIOLOGIE 1995; 84:532-541. [PMID: 7676723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
UNLABELLED Since September 1991, 204 patients (pts), 109 male and 95 female, mean age 27.3 +/- 10.6 years, were followed in a newly established interdisciplinary outpatient clinic combining both adult and pediatric cardiologists. 61 pts predominantly presented with left-to-right shunt congenital heart disease (CHD), 32 with valvar CHD, 20 with aortic coarctation, 23 with complex acyanotic, and 49 with cyanotic CHD. The population included 19 pts with Marfan syndrome. 106 pts had had previous cardiac surgery, 32 of them with up to three reoperations. Deficits and needs in medical and social care were analyzed in 100 pts using a standardized questionnaire at the time of first examination: One-third of pts were not or only incompletely informed about their CHD, previous surgical procedures and need for antibiotic prophylaxis of endocarditis. Only a minority of pts had had vocational advice (34%) or counseling concerning contraception (40%) or pregnancy (30%). Cardiac catheterization was performed in 37 pts (18%) after being first seen in our outpatient clinic, followed by a primary surgical intervention in 19 and reoperation in eight cases. Overall, 30 pts (15%) underwent surgery (28) or interventional procedures (one closure of the arterial duct, one AV node ablation after Mustard-operation) as a consequence of admission to our unit. Successful late Fontan operations were performed in four adults aged 21 to 35 years. There was 1/30 postoperative death (M. Ebstein, thrombosis of the mechanical prosthesis). The population includes five pts with severe pulmonary vascular disease (one waiting for lung transplantation) and two pts with pulmonary artery arborisation malformations not amenable to surgery. CONCLUSION In a population of 204 adolescents and adults with CHD, we clearly found deficits in medical and social care and, in addition, an unexpected high percentage of necessary invasive investigations (18%) and surgical or interventional procedures (15%). Interdisciplinary management of these patients is mandatory combining the special facilities of adult and pediatric cardiologists.
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73
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Montella S, Massari D, Pini A, Pozzoli G. [The rehabilitation of the cardiac patient in childhood. Its current status and outlook]. GIORNALE ITALIANO DI CARDIOLOGIA 1995; 25:457-62. [PMID: 7642052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A cognitive survey of the state of the art of cardiac rehabilitation in the pediatric age in Italy has been carried out, involving in the inquiry 22 Centers of Pediatric Cardiology and Cardiac Surgery, and the Italian Societies of Cardiovascular Surgery and Functional Evaluation and Cardiac Rehabilitation, to assess whether this topic has the dimensions of a social problem. The results of this investigation show that there is in Italy an increasing population of post-surgical patients, at least 3,000 per year which, together with about 500 congenital and acquired non-operated patients with heart disease, could benefit by rehabilitation, early or late according to the age. Although considered "important" by most of the inquired cardiologists and cardiac surgeons there are in Italy, up to date, only two Centers suited for pediatric cardiac rehabilitation, which, further, treat only a limited number of patients. Guidelines for functional evaluation and rehabilitative programs are needed to be applied, possibly, in selected rehabilitative Centers for adults.
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74
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Davies P. Support agencies: congenital heart disease grows up. Nurs Stand 1994; 8:22-3. [PMID: 7947127 DOI: 10.7748/ns.8.48.22.s41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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75
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76
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McGrath KA, Truesdell SC. Employability and career counseling for adolescents and adults with congenital heart disease. Nurs Clin North Am 1994; 29:319-30. [PMID: 8202404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Employability is an important issue for adolescents and young adults with congenital heart disease. This article provides an overview of specific federal laws that protect these individuals and information about state vocational rehabilitation programs. Guidelines are provided to help health care providers counsel their patients more effectively.
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77
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Koster NK. Physical activity and congenital heart disease. Nurs Clin North Am 1994; 29:345-56. [PMID: 8202406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
With advances in the diagnosis and management of congenital heart disease (CHD), the need has arisen for the assessment and counseling of patients as to appropriate physical activity levels through adulthood. Considerations to be evaluated before making exercise and athletic activity recommendations to the patient with CHD are outlined. Recommended guidelines of the American Heart Association are presented for recreational and occupational activities. Selected congenital heart defects are reviewed to address potential negative effects of incorrect recommendations.
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78
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Kaemmerer H, Tintner H, König U, Fritsch J, Sechtem U, Höpp HW. [Psychosocial problems of adolescents and adults with congenital heart defects]. ZEITSCHRIFT FUR KARDIOLOGIE 1994; 83:194-200. [PMID: 8178542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Despite successful medical treatment and hemodynamic good results after surgical correction, relevant psychosocial problems occur in adult patients with congenital heart disease. 146 patients in Germany with simple but also with complex congenital heart defects were examined by means of a questionnaire to look into these problems. Although most of the patients belonged to Ability Index I or Ability Index II of J. Somerville, almost 60% felt not healthy and impaired. The level of education was above average. 98% had attended a regular school, 23% a secondary school, and 15% had attended university. The congenital heart disease negatively affected the choice of occupation for 25% of the patients, but only 8.6% had difficulties when they applied for a job. The majority of patients was employed and satisfied with their occupation. Most of them were working in physically less demanding jobs. Sporting activities were widespread, although half of the patients felt impaired by the congenital heart disease when performing sports. All patients had some kind of health insurance. Most of them were enrolled in the common public health insurance plan. The insurers paid for almost all expenses caused by the congenital heart disease. More than 30% were not accepted by life insurance companies. Only 1.4% were members of a self-help-group for congenital heart disease. The knowledge of these occurring problems may help to improve the treatment of adult patients with congenital heart disease and, moreover, infants and adolescent patients who still have to reach adulthood may later benefit from this information.
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79
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Bretschneider-Meyer A. [Nursing home "haus der kinder". Experiences on the course of rehabilitation from a center for the aftercare for children with heart disease and their parents]. DEUTSCHE KRANKENPFLEGEZEITSCHRIFT 1993; 46:775-780. [PMID: 8261898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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80
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Uzlov FG, Gritsenko VV, Likhnitskaia II, Goncharova VA, Miroshkina VM. [Current aspects in the rehabilitation of patients with congenital heart defects]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 1993; 150:3-9. [PMID: 8379068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Repeated examinations of patients with congenital heart diseases of "pale type" (33 patients operated upon and 20 patients not subjected to operations) were performed during continuous periods of observations. A stable rehabilitative effect was noted in the group of patients operated upon who retained their physical work capacity and adequate reactions of blood circulation and ventilation systems to physical exercise. While in men the level of physical work capacity was characterized by relative constancy, in women it had a clear tendency to elevation in the dynamics of continuous terms of observation. In the group of nonoperated patients in whose childhood the congenital heart diseases were not accompanied by lung hypertension the elevated pressure in the lung artery was observed in adult age in more than half of the cases. Deterioration of functional reserves was observed in all the patients.
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81
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Goncharova VA, Gritsenko VV, Likhnitskaia II, Miroshkina VM. [Sex differences in the rehabilitative effect in patients after the correction of congenital heart defects under long-term observation]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 1993; 150:13-8. [PMID: 7701685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the process of prolonged observations a clinical and special functional examination of 33 patients (13 men and 20 women) operated upon in childhood for congenital heart diseases of the "pale type" was performed. A stable rehabilitating effect was obtained after radical surgical treatment. At the same time it was found that the level of the maximum physical work ability was retained in greater degree in women as compared with men and was even a little greater when economically used in rest and under physical load at the expense of higher gas exchange efficiency of blood circulation.
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82
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Jacobs RA, Hohn A. Cardiovascular pathology in myelomeningocele care. Eur J Pediatr Surg 1992; 2 Suppl 1:42. [PMID: 1489753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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83
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84
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Peja M, Boros A, Tóth A. [Effect of physical training on children after reconstructive heart surgery]. Orv Hetil 1990; 131:2085-6, 2089-90. [PMID: 2216436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The authors composed a programme of physical training for children with congenital valvular defect. The training programme was applied before and after the heart operation. Two years after a successful reconstructive heart operation the fitness condition of 40 children was examined. The average age of the children was 8.0 +/- 3.6 years. Twenty of the children participated and 20 did not participate in the programme. The physical condition of the children who took part in the training was found to be significantly better than that of the others without training.
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85
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Volovoĭ VL, Setrakian SA, Miasnik BN, Asanov RV. [Use of anaerobic threshold for determining the level of exercise capacity in rehabilitation of patients operated on for heart defects]. VESTNIK KHIRURGII IMENI I. I. GREKOVA 1990; 145:14-6. [PMID: 2176376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An analysis of results of spiroergometry and radionuclide ventriculography in the mixed group of cardiosurgical patients allowed to reveal a reliable accretion of fraction of expulsion of the left ventricle during transition from the state of rest to work at the level of anaerobic threshold and absence of accretion of this index in further increase of exercise. The results obtained allowed to propose the use of anaerobic threshold equal to 60% of the threshold uptake of oxygen as an indicator in choosing the optimum intensity of the training exercise of patients operated on for heart diseases.
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86
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Somerville J. 'Grown-up' survivors of congenital heart disease: who knows? Who cares? Br J Hosp Med (Lond) 1990; 43:132-6. [PMID: 2310886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
'Grown-up' congenital cardiac patients are an increasing medical community, not at present being properly cared for in any country. Information on over 2000 patients aged 15-65 years with congenital heart disease who have been treated in the National Heart Hospital provides the data for this report.
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87
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O'Brien P, Boisvert JT. Discharge planning for children with heart disease. Crit Care Nurs Clin North Am 1989; 1:297-305. [PMID: 2818881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Almost all children with heart disease are successfully cared for at home by their parents. Pediatric cardiovascular nurses play a major role in preparing parents to meet their child's medical needs, in aiding families to cope with a chronic condition, and in encouraging normal growth and development for their young patients. Through assessment, collaboration with other members of the health care team, planning with the family, teaching, counseling and supportive interventions, and evaluating care, nurses assist in a smooth transition to home and appropriate use of community resources.
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88
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Yoshida N. [Activities of a public health nurse. Outdoor achievements of a boy with a severe heart defect]. [HOKENFU ZASSHI] THE JAPANESE JOURNAL FOR PUBLIC HEALTH NURSE 1988; 44:946-7. [PMID: 3204840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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89
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Hruda J, Hrobonová V. [A pioneer camp for children after surgery of congenital heart defects]. CESKOSLOVENSKA PEDIATRIE 1988; 43:495. [PMID: 3168058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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90
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Uglov FG, Gritsenko VV, Poliakov IV. [Socioeconomic aspects of the surgical treatment of patients with congenital heart defects of the pallid type]. GRUDNAIA KHIRURGIIA (MOSCOW, RUSSIA) 1988:5-9. [PMID: 3384351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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91
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Volovoĭ VL, Guliamov DS, Gafurov FK, Abdumadzhidov KA. [Dynamic recovery of physical work capacity in patients during the first 2 years after the surgical correction of congenital heart defects with an arteriovenous shunt]. GRUDNAIA KHIRURGIIA (MOSCOW, RUSSIA) 1988:13-7. [PMID: 3384346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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92
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Yoshida Y. [Public health nurse in assisting a child with a heart defect adjusting to public school schedules]. [HOKENFU ZASSHI] THE JAPANESE JOURNAL FOR PUBLIC HEALTH NURSE 1987; 43:384-5. [PMID: 3649425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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93
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Gutgesell HP, Gessner IH, Vetter VL, Yabek SM, Norton JB. Recreational and occupational recommendations for young patients with heart disease. A Statement for Physicians by the Committee on Congenital Cardiac Defects of the Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1986; 74:1195A-1198A. [PMID: 3769178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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94
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Balfour I, Drimmer A, Nouri S. Pediatric cardiac rehabilitation: physiologic benefits. JOURNAL OF THE MEDICAL ASSOCIATION OF GEORGIA 1986; 75:560-2. [PMID: 3772274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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95
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96
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Varnauskas E, de Fernández YL, Muñoz S, Williams WH, Hatcher CR, James FW. Rehabilitation of pediatric and adolescent cardiac patients. Adv Cardiol 1986; 33:131-41. [PMID: 3565123 DOI: 10.1159/000413017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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97
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Robida A. Education and employability of young cardiac patients. Int J Cardiol 1985; 9:378-80. [PMID: 4055155 DOI: 10.1016/0167-5273(85)90036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Between 1966-1980, 136 young cardiac patients were categorized as disabled in accordance with the National Act of Rehabilitation. To study their fate a questionnaire was circulated to them: 96 patients responded, all were 15 years of age or more at the time of the study; 31.2% attended middle or higher school education and 63.3% were employed; 45.9% were skilled and 54.1% unskilled workers; 2.2% were unemployed, which was very close to the general youth unemployment rate. Work was provided for unemployed patients in their homes but they needed additional financial support. The benefits for the young disabled cardiac patients include health insurance, vocational training, payment of boarding school fees and financial support. Nevertheless the focus of the team dealing with these patients should be their preparation for employment.
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98
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Bein G. [Diseases of the heart and cardiovascular system]. DAS OFFENTLICHE GESUNDHEITSWESEN 1985; 47:379-81. [PMID: 2931653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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99
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Macartney FJ. Flying and congenital heart disease. Eur Heart J 1984; 5 Suppl A:147-54. [PMID: 6373275 DOI: 10.1093/eurheartj/5.suppl_a.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Only those congenital defects carrying a very low risk of complication (either before or after surgical correction) were considered. Atrial Septal Defects--(a) Ostium primum defects should be treated with caution either before or after surgical correction because of the risk of progressive conduction disorders and mitral regurgitation. (b) Ostium secundum defects could be considered for licensing (if the defect is small) or with surgical repair if the right ventricular systolic pressure is normal. (c) Sinus venosus defects--if too small to require surgical repair, licensing may be considered provided ambulatory electrocardiographic monitoring shows no evidence of arrhythmias. Surgery increases the risk of sino-atrial disease, thus licensing should be permitted only where there is no evidence of arrhythmia and adequate cardiological follow-up is possible. Ventricular Septal Defects--Subjects with very small defects not requiring surgical closure may be considered for licensing. Subjects who have had surgical closure have a risk of arrhythmias and should be carefully evaluated. Pulmonary Stenosis--If mild (either before or after surgery) may be licensed, but regular assessment perhaps including right heart catheterization is needed to demonstrate stability of the lesion. Persistent Ductus Arteriosus--Surgical closure should be recommended on diagnosis and need not affect licensing. Isolated Bicuspid Aortic Valve--Need not debar from licensing, but careful annual examination (with electrocardiogram 2-D echocardiography and fluroscopy ) is required to detect calcification, stenosis or regurgitation. Coarctation of aorta--Subjects who have had a repair before the age of 12 years may be considered for licensing after examination of other risk factors (blood pressure at rest and on exercise in particular). Those repaired over the age of 12 may be considered for restricted licensing if normotensive. These recommendations will need review in the light of further long-term studies currently under way.
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100
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Vaccaro P, Gallioto FM, Bradley LM, Hansen DA, Vaccaro J. Development of a Cardiac Rehabilitation Programme for Children. Sports Med 1984; 1:259-62. [PMID: 6568748 DOI: 10.2165/00007256-198401040-00001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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