Risk of Lifetime Psychiatric Morbidity in Adults With Atrial Septal Defect (from a Nation-Wide Cohort)

Nyboe, Camilla; Udholm, Sebastian; Larsen, Steffen Falgreen; Rask, Charlotte Ulrikka; Redington, Andrew N.; Hjortdal, Vibeke E.

doi:10.1016/j.amjcard.2020.04.047

Cited by 16 publications

(18 citation statements)

References 29 publications

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“…Both patients with complex and simple CHDs have neurocognitive and psychiatric comorbidities compared to the general population (7)(8)(9)(10)(11)(12)(13)(14)(15). Our findings are in line with these previous studies.…”

Section: Discussionsupporting

confidence: 91%

“…Less is found on patients with simple CHDs, even though the simple CHD is twice as common as the complex ones (2). Patients with CHDs (both complex and simple) have an increased risk of psychiatric and neurocognitive disabilities throughout life and twice the risk for being unemployed than the background population (7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Hyperactivity and Inattention in Young Patients Born With an Atrial Septal or Ventricular Septal Defect

Lau-Jensen

Asschenfeldt

Evald³

et al. 2021

Front. Pediatr.

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Background: Patients with congenital heart defects have a well-established risk of neuropsychiatric comorbidities. Inattention and hyperactivity are three to four times more frequent in children with complex congenital heart defects. We have previously shown a higher burden of overall attention deficit/hyperactivity disorder (ADHD) symptoms in adults with simple congenital heart defects as well. However, it is unknown whether the higher burden of ADHD symptoms is mainly driven by hyperactivity, inattention, or both.Methods: The participants [simple congenital heart defect = 80 (26.6 years old), controls = 36 (25.3 years old)] and a close relative for each (n = 107) responded to the long version of the Conners' Adults ADHD Rating Scales questionnaire. Our primary and secondary outcomes are mean T-scores in the ADHD scores and symptom sub-scores.Results: Patients with simple congenital heart defects reported a higher mean T-score at all three DSM-IV ADHD scores (ADHD—combined: 52.8 vs. 44.9, p = 0.007, ADHD—inattention: 55.5 vs. 46.4, p = 0.002, and ADHD—hyperactivity: 49.4 vs. 44.0, p = 0.03) and in all four ADHD symptom sub-scores (inattention/memory problems: 50.3 vs. 44.2, p = 0.001, hyperactivity/restlessness: 49.7 vs. 45.9, p = 0.03, impulsivity/emotional lability: 50.0 vs. 41.3, p = 0.001, and self-esteem problems: 53.8 vs. 46.3, p = 0.003). The results were maintained after the removal of outliers (incongruent responses), albeit the hyperactivity/restlessness ADHD symptom sub-score lost significance. Self- and informant ratings differed significantly on the ADHD—inattention score for the congenital heart defect group, where informants rated the ADHD—inattention scores better than the congenital heart defect patients rated themselves.Conclusions: Patients with a simple congenital heart defect have a higher symptom burden across all ADHD scores and all symptom sub-scores. The higher burden of ADHD is driven by both inattention and hyperactivity symptoms, though the inattention symptoms seem more prominent. Close relatives were less aware of the inattention symptoms than the congenital heart defect patients themselves. Routine screening for ADHD symptoms may be warranted to facilitate adequate help and guidance as these symptoms are easily overlooked.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03871881.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Hyperactivity and Inattention in Young Patients Born With an Atrial Septal or Ventricular Septal Defect

Lau-Jensen

Asschenfeldt

Evald³

et al. 2021

Front. Pediatr.

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“…Furthermore, adult patients with an unrepaired ASD have an increased risk of psychiatric disorders compared with the general population. 17…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, adult patients with an unrepaired ASD have an increased risk of psychiatric disorders compared with the general population. 17 Complications associated with a delayed surgical repair of ASD because of the patient's choice may allow patients to become free from a shunt, but not from advanced arrhythmias, pulmonary vasculopathy, right ventricular remodeling, or even heart failure. 18 Potential complications after ASD closure in adulthood include tachyarrhythmia, bradyarrhythmia, stroke, residual shunt, right heart failure or progressive pulmonary arterial hypertension, left atrioventricular valve regurgitation and subaortic stenosis, left atrial hypertension, and pulmonary venous congestion.…”

Section: Discussionmentioning

confidence: 99%

A large congenital atrial septal defect in an adult with delayed therapy

et al. 2021

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Patients with a large congenital atrial septal defect (ASD) traditionally have the ASD repaired at the preschool age. Unfortunately, insufficient education of patients regarding medical science and clinical recommendations can lead to delayed therapy, resulting in complications during adulthood. We report a rare case of a large congenital ASD in a 20-year-old man. Echocardiography showed a 67-mm ostium secundum defect and moderate mitral and tricuspid regurgitation. The patient underwent transthoracic ASD repair along with mitral and tricuspid valvuloplasty. This report emphasizes the importance of educating patients about congenital malformations and potential interventions in developing countries, particularly in rural communities.

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“…The long-term outcome of an ASD is believed to be benign. However, recent evidence documents that ASD patients have increased long-term morbidities such as pneumonia [ 4 ], conduction disturbances [ 5 ], atrial fibrillation [ 6 , 7 ], stroke [ 6 ], mental health issues [ 8 ] and increased mortality [ 3 ] compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

Sympathovagal imbalance decades after atrial septal defect repair: a long-term follow-up study

Alstrup

Karunanithi

Maagaard

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Recent evidence suggests that patients with a corrected atrial septal defect (ASD) have higher morbidity and mortality. An abnormal autonomic regulation of the heart may be a part of the explanation for this. Our objective was to study heart rate variability (HRV) in adults with a corrected ASD as a prominent tool to investigate the autonomic regulation of the heart. METHODS Autonomic cardiac function was investigated in adults with either a surgically closed or percutaneously closed ASD and healthy control subjects. A 48-h Holter monitor was performed on each participant and HRV was assessed. RESULTS A total of 17 patients with surgically closed ASDs, 18 percutaneously closed ASDs and 18 controls were included. The mean age in the surgical group, percutaneous group and controls was 32 ± 9, 28 ± 7 and 32 ± 10 years, respectively. The mean time since closure was 19 ± 8 years for the surgical group and 15 ± 5 years for the percutaneous group. The surgically closed ASD patients showed decreased HRV in all six parameters studied when compared to the controls. Similarly, the percutaneously closed ASDs showed decreased HRV in three out of six parameters when compared to controls. CONCLUSIONS Adults with an ASD, whether closed surgically or percutaneously, have impaired HRV compared to their age- and sex-matched controls, more so in the patients with a surgically closed ASD. Clinical trial registration number ClinicalTrials.gov (identifier: NCT03565471).

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Risk of Lifetime Psychiatric Morbidity in Adults With Atrial Septal Defect (from a Nation-Wide Cohort)

Cited by 16 publications

References 29 publications

Hyperactivity and Inattention in Young Patients Born With an Atrial Septal or Ventricular Septal Defect

Hyperactivity and Inattention in Young Patients Born With an Atrial Septal or Ventricular Septal Defect

A large congenital atrial septal defect in an adult with delayed therapy

Sympathovagal imbalance decades after atrial septal defect repair: a long-term follow-up study

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