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McGetrick ME, Riviello JJ. Neurological injury in pediatric heart disease: A review of developmental and acquired risk factors and management considerations. Semin Pediatr Neurol 2024; 49:101115. [PMID: 38677794 DOI: 10.1016/j.spen.2024.101115] [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: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 04/29/2024]
Abstract
Medical and surgical advancements have improved survival in children with acquired and congenital heart disease (CHD), but the burden of neurological morbidity is high. Brain disorders associated with CHD include white matter injury, stroke, seizure, and neurodevelopmental delays. While genetics and disease-specific factors play a substantial role in early brain injury, therapeutic management of the heart disease intensifies the risk. There is a growing interest in understanding how to reduce brain injury and improve neurodevelopmental outcomes in cardiac diseases. Pediatric neurologists serve a vital role in care teams managing these complex patients, providing interpretation of neuromonitoring and imaging, managing neurologic emergencies, assisting with neuro prognostication, and identifying future research aims.
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Affiliation(s)
- Molly E McGetrick
- Division of Cardiology and Critical Care, Department of Pediatrics, the University of Texas Southwestern, Children's Medical Center, Dallas, Texas, USA.
| | - James J Riviello
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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2
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Carazo MR. Frailty and Cognitive Function in Aging Adults With Congenital Heart Disease: A Lifetime of Limitations? J Am Coll Cardiol 2024; 83:1160-1162. [PMID: 38508849 DOI: 10.1016/j.jacc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Matthew R Carazo
- Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, California, USA.
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3
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Sood E, Newburger JW, Anixt JS, Cassidy AR, Jackson JL, Jonas RA, Lisanti AJ, Lopez KN, Peyvandi S, Marino BS. Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e997-e1022. [PMID: 38385268 DOI: 10.1161/cir.0000000000001211] [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: 02/23/2024]
Abstract
Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.
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Srinivas S, Vignesh Rk B, Ayinapudi VN, Govindarajan A, Sundaram SS, Priyathersini N. Neurological Consequences of Cardiac Arrhythmias: Relationship Between Stroke, Cognitive Decline, and Heart Rhythm Disorders. Cureus 2024; 16:e57159. [PMID: 38681361 PMCID: PMC11056008 DOI: 10.7759/cureus.57159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
Cardiac arrhythmias are one of the most common disorders with high morbidity and mortality. The effect of cardiac arrhythmias on the brain is very pronounced due to the high sensitivity of the brain to oxygen and blood supply. This mortality is preventable by early diagnosis and treatment which improves the patient's quality of life. Intervening at the right time, post arrhythmia is significant in preventing deaths and improving patient outcomes. Multiple pathophysiological mechanisms are studied for the brain-axis implications, that have the potential to be targeted by novel therapies. In this review, we describe the pathophysiological mechanisms and recent advances in detail to understand the functional aspects of the brain-heart axis and neurological implications post-stroke, caused by cardiac disorders. This paper aims to discuss the current literature on the neurological consequences of cardiac arrhythmias and delve into a deeper understanding of the brain-heart axis, imbalances, and decline, with the aim of summarizing everything and all about the neurological consequences of cardiac arrhythmias.
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Affiliation(s)
- Swathi Srinivas
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Bharath Vignesh Rk
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | | | | | | | - N Priyathersini
- Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, IND
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Abboud F, Easson K, Majnemer A, Rohlicek CV, Brossard-Racine M. Psychological Well-Being, Everyday Functioning, and Autonomy In Emerging Adults with a Congenital Heart Defect. J Pediatr 2023; 262:113621. [PMID: 37473990 DOI: 10.1016/j.jpeds.2023.113621] [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] [Received: 04/20/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To characterize the psychological well-being, everyday functioning, and autonomy of emerging adults with congenital heart disease (CHD) and explore how they relate to the executive function (EF) deficits commonly observed in this population. STUDY DESIGN Questionnaires assessing psychological well-being (encompassing psychosocial functioning and resilience), EF, and age-appropriate indicators of everyday function and autonomy (eg, housing, education, employment, relationship status) were completed by participants with CHD (16-26 years) who underwent open-heart surgery during infancy and age- and sex-matched controls. RESULTS A total of 58 emerging adults with CHD and 57 controls participated in this study. Mean scores on the resilience and psychosocial functioning questionnaires were not significantly different between CHD and control participants. Emerging adults with CHD also did not differ from controls in terms of holding a driver's license, involvement in a romantic relationship, or current employment status. Multiple linear regression identified that better EF was associated with better psychological well-being. CONCLUSIONS This study supports the need for systematic screening for EF deficits during adolescence and early adulthood to promote optimal well-being in this population. Further research is required to continue to document the everyday experiences of adolescents and young adults with CHD to identify protective factors associated with a successful and satisfying transition to adult life.
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Affiliation(s)
- Fatme Abboud
- Advances in Brain and Child Health Development Research Laboratory, Research Institute of the McGill University Health Center, Montreal, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Kaitlyn Easson
- Advances in Brain and Child Health Development Research Laboratory, Research Institute of the McGill University Health Center, Montreal, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Annette Majnemer
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Division of Neurology, Department of Pediatrics, McGill University Health Center, Montreal, Canada
| | - Charles V Rohlicek
- Division of Cardiology, Department of Pediatrics, McGill University Health Center, Montreal, Canada
| | - Marie Brossard-Racine
- Advances in Brain and Child Health Development Research Laboratory, Research Institute of the McGill University Health Center, Montreal, Canada; Department of Neurology and Neurosurgery, McGill University, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Division of Cardiology, Department of Pediatrics, McGill University Health Center, Montreal, Canada; Division of Neonatology, Department of Pediatrics, McGill University Health Center, Montreal, Canada.
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6
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Faim D, Tiago J, Castelo R, Francisco A, Alves R, Pires A. Congenital Heart Disesase: A Retrospective Analysis from a Tertiary Referral Centre in Portugal. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lu N, Smith JMC, Andrade JG, Flexman AM, Field TS. Considerations in Adult Congenital Heart Disease and Stroke: A Case Report. Stroke 2020; 51:e148-e150. [PMID: 32576089 DOI: 10.1161/strokeaha.119.028605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nelson Lu
- University of British Columbia Faculty of Medicine, Vancouver, Canada (N.L.). Vancouver Stroke Program, Division of Neurology, University of British Columbia, British Columbia, Canada (J.M.C.S., T.S.F.). Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.G.A.). Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A.). Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, British Columbia, Canada (A.M.F.). Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada (A.M.F.)
| | - Jonathan M C Smith
- University of British Columbia Faculty of Medicine, Vancouver, Canada (N.L.). Vancouver Stroke Program, Division of Neurology, University of British Columbia, British Columbia, Canada (J.M.C.S., T.S.F.). Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.G.A.). Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A.). Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, British Columbia, Canada (A.M.F.). Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada (A.M.F.)
| | - Jason G Andrade
- University of British Columbia Faculty of Medicine, Vancouver, Canada (N.L.). Vancouver Stroke Program, Division of Neurology, University of British Columbia, British Columbia, Canada (J.M.C.S., T.S.F.). Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.G.A.). Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A.). Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, British Columbia, Canada (A.M.F.). Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada (A.M.F.)
| | - Alana M Flexman
- University of British Columbia Faculty of Medicine, Vancouver, Canada (N.L.). Vancouver Stroke Program, Division of Neurology, University of British Columbia, British Columbia, Canada (J.M.C.S., T.S.F.). Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.G.A.). Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A.). Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, British Columbia, Canada (A.M.F.). Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada (A.M.F.)
| | - Thalia S Field
- University of British Columbia Faculty of Medicine, Vancouver, Canada (N.L.). Vancouver Stroke Program, Division of Neurology, University of British Columbia, British Columbia, Canada (J.M.C.S., T.S.F.). Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (J.G.A.). Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A.). Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, British Columbia, Canada (A.M.F.). Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada (A.M.F.)
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