New trends in the management of congenital heart disease

Does the severity of congenital heart defects affect disease-specific health-related quality of life in children in Bosnia and Herzegovina?

The aim of this study was to assess whether the severity of congenital heart defects (CHD) affects disease-specific health-related quality of life (HRQOL) in children after open heart surgery. One hundred and fourteen children with CHD and one of their parents participated in the study. HRQOL was evaluated by the PedsQL 3.0 Cardiac Module. The children were assigned to one of three groups according to severity of CHD. Children with cyanotic CHD (Group 3) reported that their HRQOL on several domains was lower than that of children with anomalies with the left-right shunt and children with obstructive anomalies. Also, by parent proxy-report, patients with anomalies with the left-right shunt had statistically significant, better HRQOL scores for the heart problems and treatment scales, perceived physical appearance, treatment anxiety, cognitive problems, and communication scales in comparison to the children with cyanotic CHD. By self-report, children of Group 1 reported that they had statistically significant, better HRQOL in the heart problems and treatment scales compared with Group 2.

CONCLUSIONS

The results of the assessment by the PedsQL 3.0 Cardiac Module, a cardiac disease-specific instrument for children with CHD, indicate that HRQOL is poorest in children with complex CHD. Therefore, it is necessary to take the appropriate preventive measures for these patients, which include early (timely) cardiosurgical intervention and active psychological support to limit the negative impact of serious forms of CHD on the quality of life of these children.

Preserved flow-mediated dilation in adults with cyanotic congenital heart disease

Adults with cyanotic congenital heart disease (CCHD) have been shown to have endothelial dysfunction in the forearm resistance vessels as assessed with venous occlusion plethysmography. Whether these abnormalities are confined to the microvasculature or reflect generalized endothelial dysfunction remain unknown. We used high-resolution ultrasound to compare flow responses and endothelial-dependent flow-mediated dilation (FMD) in the brachial artery of 13 adult patients with CCHD and 14 healthy controls. High-dose vitamin C was infused to evaluate the possible role of reactive oxygen species on endothelial vasomotor function. FMD was measured both prior to and after vitamin C infusion. Sublingual glyceryl nitrate was given to assess endothelium-independent responses. FMD did not differ among patients with CCHD and controls either before (6.2 +/- 4.1, 5.1 +/- 2.6%, p = 0.44) or after (5.1 +/- 2.8, 5.2 +/- 3.1%, p = 0.90) vitamin C infusion. Endothelium-independent vasodilatation was similar in both groups (14.3 +/- 3.7, 13.2 +/- 4.4%). There were no differences in baseline flow or in measures of reactive hyperemia. Adults with CCHD appear to have preserved endothelial function in their conduit arteries. This suggests that these patients are not at an increased risk of premature atherosclerotic cardiovascular events.