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Lau-Jensen SH, Berg CF, Hejl JL, Baker K, Rask CU, Hjortdal VE. Psychiatric co-morbidity in children and adolescents with CHDs: a systematic review. Cardiol Young 2023; 33:1791-1799. [PMID: 37565328 DOI: 10.1017/s1047951123003013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The population of long-term survivors with CHDs is increasing due to better diagnostics and treatment. This has revealed many co-morbidities including different neurocognitive difficulties. However, the prevalence of psychiatric disorders among children and adolescents and the specific types of disorders they may experience are unclear. We systematically reviewed the existing literature, where psychiatric diagnoses or psychiatric symptoms were investigated in children and adolescents (age: 2-18 aged) with CHDs and compared them with a heart-healthy control group or normative data. The searches were done in the three databases PubMed, psychINFO, and Embase. We included 20 articles reporting on 8035 unique patients with CHDs. Fourteen articles repoted on psychological symptoms, four reported on psychiatric diagnoses, and two reported on both symptoms and diagnoses. We found that children and adolescents with a CHD had a higher prevalence of attention deficit hyperactivity disorder (ranging between 1.4 and 9 times higher) and autism (ranging between 1.8 and 5 times higher) than controls, but inconsistent results regarding depression and anxiety.
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Affiliation(s)
- Sara H Lau-Jensen
- Department of Cardiothoracic Surgery, Rigshospitalet, Kobenhavn, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Christian F Berg
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Julie L Hejl
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kamillia Baker
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Rigshospitalet, Kobenhavn, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
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Josowitz R, Linn R, Rychik J. The Placenta in Congenital Heart Disease: Form, Function and Outcomes. Neoreviews 2023; 24:e569-e582. [PMID: 37653088 DOI: 10.1542/neo.24-9-e569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The maternal-fetal environment, controlled and modulated by the placenta, plays a critical role in the development and well-being of the fetus, with long-term impact through programming of lifelong health. The fetal cardiovascular system and placenta emerge at the same time embryologically, and thus placental form and function are altered in the presence of congenital heart disease (CHD). In this review, we report on what is known about the placenta from a structural and functional perspective when there is CHD. We describe the various unique pathologic findings as well as the diagnostic imaging tools used to characterize placental function in utero. With growing interest in the placenta, a standardized approach to characterizing placental pathology has emerged. Furthermore, application of ultrasonography techniques and magnetic resonance imaging now allow for insights into placental blood flow and functionality in vivo. An improved understanding of the intriguing relationship between the placenta and the fetal cardiovascular system will provide opportunities to develop novel ways to optimize outcomes. Once better understood, therapeutic modulation of placental function offered during the vulnerable period of fetal plasticity may be one of the most impactful ways to alter the course of CHD and its complications.
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Affiliation(s)
- Rebecca Josowitz
- Division of Cardiology, Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Rebecca Linn
- Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Jack Rychik
- Division of Cardiology, Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
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Omann C, Kristensen R, Tabor A, Gaynor JW, Hjortdal VE, Nyboe C. School performance is impaired in children with both simple and complex congenital heart disease. Front Pediatr 2023; 11:1073046. [PMID: 36911031 PMCID: PMC9995927 DOI: 10.3389/fped.2023.1073046] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Background We do not know if children born with a simple or uncorrected congenital heart disease (CHD) have school performance issues and an increased need for special education compared to healthy peers. With this study we examine the school performance and the need for special education in children with both simple and complex CHD. Further, we evaluate if exposure to preeclampsia or smoking affects the need for special education. Methods In this nation-wide population based registry study, we included all Danish children with CHD born 1994-2012. In addition ten age and gender matched control per CHD child were included. Non-singletons and children born with a syndrome were excluded. Exposure was defined as having a CHD and the outcome was defined as needing special education service in the Danish primary and lower secondary school. Results The population consisted of 7,559 CHD children and 77,046 non-CHD children (controls). CHD children had a higher need for special education compared to non-CHD children, OR: 2.14 (95% CI: 2.00; 2.28), p < 0.001. The odds ratio was also increased when comparing children with a minor CHD to non-CHD children, OR: 1.99 (95% CI: 1.86; 2.14), p < 0.001. CHD children exposed to preeclampsia or smoking had a higher risk of receiving special education compared to unexposed CHD children. Conclusion We find that school performance is impaired in children born with CHD. This applies to both simple and complex CHD. If a child with CHD was exposed to preeclampsia or maternal smoking this further increased the need for special education.
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Affiliation(s)
- Camilla Omann
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rasmus Kristensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Camilla Nyboe
- Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Kristensen R, Omann C, Gaynor JW, Rode L, Ekelund CK, Hjortdal VE. Increased nuchal translucency in children with congenital heart defects and normal karyotype-is there a correlation with mortality? Front Pediatr 2023; 11:1104179. [PMID: 36873643 PMCID: PMC9981958 DOI: 10.3389/fped.2023.1104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/09/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES Our objective was to investigate if an increased nuchal translucency (NT) was associated with higher mortality in chromosomally normal children with congenital heart defects (CHD). METHODS In a nationwide cohort using population-based registers, we identified 5,633 liveborn children in Denmark with a pre- or postnatal diagnosis of CHD from 2008 to 2018 (incidence of CHD 0.7%). Children with chromosomal abnormalities and non-singletons were excluded. The final cohort compromised 4,469 children. An increased NT was defined as NT > 95th-centile. Children with a NT > 95th-centile vs. NT < 95th-centile including subgroups of simple- and complex CHD were compared. Mortality was defined as death from natural causes, and mortalities were compared among groups. Survival analysis with Cox-regression was used to compare rates of mortality. Analyses were adjusted for mediators (possibly explanatory factors between increased NT and higher mortality): preeclampsia, preterm birth and small for gestational age. And for confounding effects of extracardiac anomalies and cardiac intervention, due to their close association to both the exposure and the outcome (i.e., confounders). RESULTS Of the 4,469 children with CHD, 754 (17%) had complex CHD and 3,715 (83%) simple CHD. In the combined group of CHDs the mortality rate was not increased when comparing those with a NT > 95th-centile to those with a NT < 95th-centile [Hazard ratio (HR) 1.6, 95%CI 0.8;3.4, p = 0.2]. In simple CHD there was a significantly higher mortality rate with a HR of 3.2 (95%CI: 1.1;9.2, p = 0.03) when having a NT > 95th centile. Complex CHD had no differences in mortality rate between a NT > 95th-centile and NT < 95th-centile (HR 1.1, 95%CI: 0.4;3.2, p = 0.8). All analysis adjusted for severity of CHD, cardiac operation and extracardiac anomalies. Due to limited numbers the association to mortality for a NT > 99th centile (>3.5 mm) could not be assessed. Adjustment for mediating (preeclampsia, preterm birth, small for gestational age) and confounding variables (extracardiac anomalies, cardiac intervention) did not alter the associations significantly, except for extracardiac anomalies in simple CHD. CONCLUSION An increased NT > 95th-centile is correlated with higher mortality in children with simple CHD, but the underlying cause is unknown and undetected abnormal genetics might explain the correlation rather than the increased NT itself, hence further research is warranted.
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Affiliation(s)
- Rasmus Kristensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Camilla Omann
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiothoracic & Vascular Surgery, Aarhus University Hospital, Skejby, Denmark
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Line Rode
- Department of Obstetrics, Center for Fetal Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet Glostrup, Glostrup, Denmark
| | - Charlotte K Ekelund
- Department of Obstetrics, Center for Fetal Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Vibeke E Hjortdal
- Department of Cardiothoracic Surgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Bäck M, Banach M, Braunschweig F, De Rosa S, Gimelli A, Kahan T, Ketelhuth DFJ, Lancellotti P, Larsson SC, Mellbin L, Nagy E, Savarese G, Szummer K, Wahl D. Highlights from 2022 in EHJ Open. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac084. [PMID: 36600883 PMCID: PMC9801405 DOI: 10.1093/ehjopen/oeac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Magnus Bäck
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
- Nancy University Hospital, University of Lorraine and INSERM U1116, 54511 Nancy, France
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz and Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Frieder Braunschweig
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alessia Gimelli
- Cardiovascular and Imaging Departments, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Thomas Kahan
- Department of Cardiology, Danderyd University Hospital, Stockohlm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Daniel F J Ketelhuth
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, University of Liège Hospital, Centre Hospitalier Universitaire Sart Tilman, Liège, Belgium
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Linda Mellbin
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Edit Nagy
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Gianluigi Savarese
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Karolina Szummer
- Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Denis Wahl
- Nancy University Hospital, University of Lorraine and INSERM U1116, 54511 Nancy, France
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