Kids with heart defects may face future problems

NEW YORK (Reuters Health) - Children who undergo open-heart surgery to repair heart defects may have more psychological adjustment problems and worse quality of life than kids with healthy hearts, according to a new review of 35 studies.

The young people who had more complex heart defects, as well as those who were likely to need future surgery, were at the greatest risk of these problems, as were those with neurological and developmental impairment, Dr. Markus A. Landolt of the University Children's Hospital in Zurich and his colleagues found.

Up to 12 of every 1,000 babies has congenital heart disease, and more than one third of these cases involves life-threatening heart malformations, Landolt and his team note in their report in BMC Pediatrics. More and more children are surviving and living longer after surgery to repair these defects, they add, and coping with the surgery can be a challenge to both parents and children.

To investigate how children fare psychologically after this type of surgery, Landolt and his team identified and reviewed 23 studies looking at psychological adjustment in these patients and 12 studies examining quality of life. In all of the studies, participants were followed for at least two years.

Children who had undergone surgery were about twice as likely to have a psychiatric diagnosis as healthy kids, similar to the risk seen among kids with other types of chronic illness, the researchers found. These young people were also more likely to exhibit behavior concerned to be outside the normal range, and to have problems with psychological function.

However, the parents of children with transposition of the major heart arteries reported that their children as well adjusted -- or even better adjusted -- than healthy controls. This may be because the defect has an "excellent prospect" of being corrected with surgery, and also because these children were less likely than kids with other types of heart defects to have genetic disorders, Landolt and his team suggest.

When teachers rather than parents were asked about children's behavior and adjustment, they reported no difference between the children with heart disease and healthy controls, suggesting that "the children's difficulties are less apparent within the schooling context," the researchers write. This could be because the children are more likely to have "internalizing" problems than problems that involve acting out, and could also be related to the influence of parental anxieties on how they perceive their children, according to the researchers.

Similarly, in the studies of quality of life, parents were more likely than the children themselves to report that the child had impaired quality of life.

"Parental well-being seems to be related to psychological adjustment in these children," the researchers say. "This calls for an integrated approach to family support, taking the child's individual needs into account as well as the needs of the parents," they conclude.

SOURCE: BMC Pediatrics, January 22, 2009.