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McCormick AD, Owens ST, Lim HM, Vitale C, Dusing C, Rea KE, Pierce J, Malas N, Cousino MK. A Novel Mental Health Curriculum Pilot for Pediatric Cardiology Fellows: Preparing the Subspecialist to Expand the Team. Pediatr Cardiol 2024:10.1007/s00246-024-03532-7. [PMID: 38836879 DOI: 10.1007/s00246-024-03532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
Mental health (MH) is an important, yet understudied area of care for patients with congenital heart disease (CHD). Pediatric subspecialty fellows believe MH should be within their scope of practice, but few feel confident in their ability to appropriately screen, evaluate, manage, and make treatment referrals for youth with CHD and concurrent MH concerns. A 6-session, didactic-based curriculum was designed by an interprofessional team of experts. It was administered to pediatric cardiology fellows over 9 months during two academic years. Topics included the following: Introduction to MH and CHD, MH Screening and Clinic-Based Interventions, Psychopharmacology, Delirium, Trauma-Informed Care, and Adult CHD and Transitional Care. An investigator-designed survey was developed to assess fellow comfort with MH knowledge, screening, and treatment recommendation domains. Twenty-three fellows participated with 14 completing the pre-post survey (58% participation, 11/17 in year 1, 3/6 in year 2). Most participants were in their first year of training (9/14, 57%). Overall, fellow comfort with MH topics increased significantly (mean score 2.89 ± 0.46 vs. 3.4 ± 0.4, p = 0.0005), with improved comfort in the MH knowledge (p = 0.003) and treatment recommendation domains (p = 0.001). A didactic-based MH curriculum improves the comfort of pediatric cardiology fellows to address the MH concerns of their patients. The topics in this curriculum will continue to be refined over time and could be generalized to training programs, both nationally and across pediatric specialties, to improve MH care for high-risk populations.
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Affiliation(s)
- Amanda D McCormick
- Division of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA.
| | - Sonal T Owens
- Division of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA
| | - Heang M Lim
- Division of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA
| | - Carolyn Vitale
- Division of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children's Hospital, Michigan Medicine, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA
| | - Catherine Dusing
- Division of Pediatric Psychology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Kelly E Rea
- Division of Pediatric Psychology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Jessica Pierce
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
| | - Nasuh Malas
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, USA
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Melissa K Cousino
- Division of Pediatric Psychology, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
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Dardas LA, Al-Ammouri I, Sweis S, Eid A, Abid M, Pan W. Beyond the heart: Cognitive and verbal outcomes in Arab children with congenital heart diseases. Birth Defects Res 2024; 116:e2374. [PMID: 38923365 DOI: 10.1002/bdr2.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/12/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND This study investigates how congenital heart diseases (CHD) characteristics and interventions affect cognitive and verbal skills in Arab children, while also uncovering previously unexplored connections between these skills and the quality of life (QoL) scores as perceived by both children and parents. METHODS A cross-sectional study was conducted in Jordan, involving 62 children with CHD aged 6-16. Data were collected through standardized intelligence tests (namely The Raven's Progressive Matrices Test and The Wechsler Intelligence Scale for Children) and QoL assessments. RESULTS Sex, disease severity, cyanosis, CHD defect status, conducted operations, and types of interventions did not significantly influence cognitive scores. However, a significant difference was observed in Wechsler's scores between cyanotic and non-cyanotic children (p < .01) and between severe and moderate cases (p = .01). Further, a significant positive correlation was identified between Wechsler's Scores and QoL reported by parents (r = 0.33, p < .01). This correlation was particularly pronounced in the social and school functioning dimensions of QoL. CONCLUSIONS This study highlights the need for personalized care approaches for children with CHDs based on their individual characteristics. While cognitive abilities did not directly correlate with children's QoL reports, a significant positive correlation between verbal skills and QoL reported by parents underscores the importance of effective communication in assessing a child's overall well-being. Future research should further examine the cognitive development in this population, employing neurocognitive investigations and longitudinal studies to gain a deeper understanding of their cognitive profiles and trajectories.
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Affiliation(s)
| | | | - Sami Sweis
- The University of Jordan, Aljubeiha, Amman, Jordan
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Hidestrand P, Svensson B, Simpson P, Liuba P, Weismann CG. Impact of Underweight, Overweight, and Obesity on Health-Related Quality of Life in Children with Tetralogy of Fallot Variants. Pediatr Cardiol 2024:10.1007/s00246-024-03416-w. [PMID: 38506963 DOI: 10.1007/s00246-024-03416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/10/2024] [Indexed: 03/22/2024]
Abstract
Traditional cardiovascular risk factors put patients with congenital heart disease (CHD) at increased risk for cardiovascular morbidity and mortality. The aim of this study was to evaluate whether body mass index (BMI) is associated with health-related quality of life (HRQoL) in patients with variants of Tetralogy of Fallot (TOF). Patients and parents of children with variants of TOF-CHD were asked to fill out the PedsQL 4.0 questionnaire and provide weight and length. Patients were categorized into low, normal, and high BMI percentiles. Other demographic data were obtained from the Swedish national registry for congenital heart disease (SWEDCON). Statistical analyses included non-parametric Mann-Whitney U test, Fisher exact, and Chi-square tests. Eighty-five patients were included. Twelve were overweight or obese, 57 had a normal BMI, and 16 were underweight. There was a significant difference in age and gender between the groups. Comparing overweight/obese children to those with normal BMI, physical and social functioning were impaired, while emotional and school function were comparable between the groups. This applied to both child and parental assessment. When comparing underweight to normal weight children, school functioning assessed by the parent was the only domain significantly different from patients with a normal BMI. Children with variants of TOF and overweight/obesity have lower HRQoL, particularly in physical and social functioning, while underweight children may have impaired school functioning. We suggest that preventive measures aimed at maintaining a normal weight should be taken early in life to reduce long-term cardiovascular risk in the CHD population.
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Affiliation(s)
- Pip Hidestrand
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
- Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Birgitta Svensson
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Petru Liuba
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Constance G Weismann
- Department of Pediatric Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University, Munich, Germany
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Bsesa SS, Srour S, Dashash M. Oral health-related quality of life and oral manifestations of Syrian children with congenital heart disease: a case-control study. BMC Oral Health 2023; 23:316. [PMID: 37221589 DOI: 10.1186/s12903-023-03017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND There was an immense need for studies evaluating the oral health status of Syrian children with congenital heart disease (CHD) and its impact on their quality of life. No contemporary data are available. The objective of this study was to investigate oral manifestations and oral health-related quality of life (OHRQoL) of children with CHD and compare them with healthy controls aged 4-12 years. METHODS A case-control study was undertaken. A total of 200 patients with CHD and 100 healthy children belonging to the same patient's family were included. Decayed, missed, and filled permanent teeth index (DMFT) and decayed, missed, and filled primary teeth index (dmft), Oral Hygiene Index (OHI), Papillary Marginal Gingivitis Index (PMGI), and dental abnormalities were recorded. The Arabic version of the Child Oral Health-Related Quality of Life Questionnaire (COHRQoL, 36-item) which was divided into 4 different domains (Oral Symptoms, Functional Limitations, Emotional Well-Being, Social Well-Being) were studied. Chi-square test and independent- t-test were used to perform statistical analysis. RESULTS CHD patients experienced more periodontitis, dental caries, poor oral health, and enamel defects. The dmft mean was significantly higher in CHD patients than in healthy children (5.245 vs. 2.660, P < 0.05). No significant difference was found between patients and controls in the DMFT Mean (P = 0.731). There was a significant difference between CHD patients and healthy children in the mean of the OHI (5.954 vs. 1.871, P < 0.05), and PMGI (1.689 vs. 1.170, P < 0.05). CHD patients have significantly higher enamel opacities (8% vs. 2%) and hypocalcification (10.5% vs. 2%) than controls. Also, the 4 COHRQoL domains, showed significant differences between CHD children and controls. CONCLUSIONS Evidence about the oral health and COHRQoL of children with CHD was provided. Further preventive measures are still required to improve the health and quality of life of this vulnerable group of children.
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Affiliation(s)
- Shouq Sharar Bsesa
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria.
| | - Samir Srour
- Department of Pediatric Cardiology, The University Pediatric Hospital of Damascus, Damascus, Syria
| | - Mayssoon Dashash
- Department of Pediatric Dentistry, Faculty of Dentistry, Damascus University, Damascus, Syria
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Lang L, Gerlach J, Plank AC, Purbojo A, Cesnjevar RA, Kratz O, Moll GH, Eichler A. Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement. J Clin Med 2022; 11:jcm11237242. [PMID: 36498814 PMCID: PMC9738920 DOI: 10.3390/jcm11237242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6-9 years) to adolescence (10-14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times-when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients' quality of life was increased and internalizing problems were decreased-proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions.
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Affiliation(s)
- Laura Lang
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Jennifer Gerlach
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anne-Christine Plank
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Ariawan Purbojo
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Robert A. Cesnjevar
- Department of Pediatric Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Department of Pediatric Cardiovascular Surgery, Pediatric Heart Center, University Children’s Hospital Zürich, 8032 Zürich, Switzerland
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Gunther H. Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Anna Eichler
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
- Correspondence:
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Suratham S, Prasopkittikun T, Srichantaranit A, Vongsirimas N. A causal model for health-related quality of life among Thai adolescents with congenital heart disease. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-11-2020-0520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The objective of this study was to examine the causal relationships among sex, social support, disease severity, symptoms, physical activity, general health perception and health-related quality of life (HRQOL) in Thai adolescents with congenital heart disease (CHD).
Design/methodology/approach
A cross-sectional study was conducted using convenience sampling to recruit 200 Thai adolescents with CHD aged between 13 and18 years from four tertiary university hospitals in Bangkok. Interview method and self-administered questionnaires were used for data collection held between November 2018 and February 2019. Data were analyzed using path analysis to test the hypothesized model of the relationships.
Findings
The causal model of HRQOL revealed a good fit with the data. This model of relationship could explain 48% of the variances in HRQOL. Only direct effects of disease severity, symptoms and social support on HRQOL were found while indirect effects were not.
Originality/value
Due to the lack of study focusing on factors influencing HRQOL in Thai adolescents with CHD, this empirical study provides the evidence in Thai literature. The modifiable influencing factors for HRQOL found in this study can be manipulated through psycho-educational intervention given to the adolescents and significant others, especially parents, to help increase quality of life in adolescents with CHD.
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Sertçelik T, Alkan F, Sapmaz ŞY, Coşkun Ş, Eser E. Life quality of children with congenital heart diseases. Turk Arch Pediatr 2018; 53:78-86. [PMID: 30116128 DOI: 10.5152/turkpediatriars.2018.6428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/21/2018] [Indexed: 11/22/2022]
Abstract
Aim We aimed to evaluate the effects of the severity and symptoms of congenital heart disease and the emotional and behavioral problems of affected children on their quality of life. Material and Methods The study was performed by interviewing 80 children aged between 6 and 16 years (40 with cyanotic heart disease and 40 with acyanotic disease) and their mothers. A sociodemographic data form, quality of life questionnaire, strength and difficulties questionnaire, and family life and parenting attitudes scale were used in the research. Life quality was the dependent variable of this research. Results No significant relation was found between age, sex, and education level of the parents and all quality of life subscale scores (p>0.05). In terms of quality of life, total quality of life subscale, emotional well-being and self-esteem subscales were significantly lower in children with cyanotic congenital heart disease (p=0.02, p=0.007, p=0.006, respectively). The total quality of life subscale was significantly lower in children with a medical treatment and surgical history. In terms of clinical symptoms, self-esteem, friendship and school life quality subscales were affected in the presence of dyspnea. As scores from strength and difficulties questionnaire increased, which is used for the assessment of children's psychological symptoms, all quality of life scores were significantly lowered except for school and family subscales. Conclusion It was found that symptoms of congenital heart disease affected the psychosocial quality of life subscales rather than the physical subscales. In addition, it was observed that mental symptoms in both the mother and child negatively affected quality of life rather than disease-related parameters.
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Affiliation(s)
- Tamay Sertçelik
- Department of Pediatrics, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Fatoş Alkan
- Department of Pediatrics, Division of Pediatric Cardiology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Şermin Yalın Sapmaz
- Department of Child Psychiatry, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Şenol Coşkun
- Department of Pediatrics, Division of Pediatric Cardiology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Erhan Eser
- Department of Public Health, Celal Bayar University School of Medicine, Manisa, Turkey
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Mulkey SB, Bai S, Luo C, Cleavenger JE, Gibson N, Holland G, Mosley BS, Kaiser JR, Bhutta AT. School-Age Test Proficiency and Special Education After Congenital Heart Disease Surgery in Infancy. J Pediatr 2016; 178:47-54.e1. [PMID: 27453376 PMCID: PMC5295644 DOI: 10.1016/j.jpeds.2016.06.063] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/11/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate test proficiency and the receipt of special education services in school-age children who had undergone surgery for congenital heart disease (CHD) at age <1 year. STUDY DESIGN Data from Arkansas-born children who underwent surgery for CHD at Arkansas Children's Hospital at age <1 year between 1996 and 2004 were linked to state birth certificates and the Arkansas Department of Education longitudinal database containing achievement test scores in literacy and mathematics for grades 3-4 and special education codes. The primary negative outcome was not achieving grade-level proficiency on achievement tests. Logistic regression accounting for repeated measures was used to evaluate for associations between achieving proficiency and demographic data, maternal education, and clinical factors. RESULTS A total of 362 of 458 (79%) children who underwent surgery for CHD were matched to the Arkansas Department of Education database, 285 of whom had grade 3 and/or 4 achievement tests scores. Fewer students with CHD achieved proficiency in literacy and mathematics (P < .05) compared with grade-matched state students. Higher 5-minute Apgar score, shorter duration of hospitalization, and higher maternal education predicted proficiency in literacy (P < .05). White race, no cardiopulmonary bypass, and shorter hospitalization predicted proficiency in mathematics (P < .05). Sex, gestational age, age at surgery, CHD diagnosis, and type and number of surgeries did not predict test proficiency. Compared with all public school students, more children with CHD received special education services (26.9% vs 11.6%; P < .001). CONCLUSION Children with CHD had poorer academic achievement and were more likely to receive special education services than all state students. Results from this study support the need for neurodevelopmental evaluations as standard practice in children with CHD.
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Affiliation(s)
- Sarah B. Mulkey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR,Center for Translational Neuroscience, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Shasha Bai
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Chunqiao Luo
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Neal Gibson
- Arkansas Research Center, University of Central Arkansas, Conway, AR
| | - Greg Holland
- Arkansas Research Center, University of Central Arkansas, Conway, AR
| | - Bridget S. Mosley
- Section of Birth Defects Research, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jeffrey R. Kaiser
- Departments of Pediatrics and Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Adnan T. Bhutta
- Department of Pediatrics, University of Maryland, Baltimore, MD
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Fragata J. Shall we treat congenital heart lesions, their suffering patients or also their families, and surrounding societal ambience? Transl Pediatr 2013; 2:87-9. [PMID: 26835298 PMCID: PMC4728934 DOI: 10.3978/j.issn.2224-4336.2013.07.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Results with the treatment of congenital heart defects (CHD) have improved markedly. However these patients, in their teens and adulthood ages, suffer from psychological dysfunctions of different natures, even psychiatric diseases, that must by thought and be properly managed. Not only these dysfunctions are related to clinical history profiles, but they are clearly related to social support, with impacts on the way quality of life (QOL) is perceived. This new vision creates a window of opportunities to act, now, on the aspect of their social modelling and psychological support, to improve QOL and psychological adaptation for these patients, already living longer, in order to make them living better.
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Affiliation(s)
- José Fragata
- Department Cardiothoracic and Congenital Heart Surgery, Hospital de Santa Marta, Nova Medical School, Lisbon, Portugal
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Daudt NS, Zielinsky P. Late outcomes of congenital heart disease. Transl Pediatr 2013; 2:84-6. [PMID: 26835297 PMCID: PMC4728936 DOI: 10.3978/j.issn.2224-4336.2013.07.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In our days, more than 90% of children with congenital heart disease (CHD) reach adolescence and adult life, and therapeutic procedures are performed with late quality of life (QOL) in mind. Rates of success are now assessed at long range by sequels, residues and adaptation of the individuals to normality. The attempt to identify factors to avoid psychopathological sequels in this group of "new" cardiac patients is one of the most important aspects of studies on late outcome of congenital heart disease. This fact remains valid in the current era and is in consonance with the attitude to more and more value child-adolescent and adolescent-adult transitions in patients with CHD submitted or not to surgical or percutaneous intervention in childhood. Resilience and ability to adapt could also be improved by a multiprofessional approach of attitudes, abilities and psychological characteristics, aiming to prevent the psychopathologic effects of the disease.
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Affiliation(s)
- Nestor Santos Daudt
- Division of Pediatric Cardiology, Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Zielinsky
- Division of Pediatric Cardiology, Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil
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