Background: In Germany 1 out of 100 children are born with a congenital heart defect (CHD); of
these children 3 out of 1000 need early corrective surgery. Ventricular Septal Defect
(VSD) is the most common CHD with a prevalence between 20% and 49%. Early detection
and surgical correction of a VSD is possible, resulting in no further cardiac impairments
in most cases, however little is known regarding the psychological adjustment of affected
children. Former studies investigating psychological well-being in children and adolescents
with CHD did not consider a homogenous VSD cohort; furthermore, single outcome measures
of adjustment were used instead of a wide range of developmental outcome measures.
Hypotheses: The current study investigated the long-term impact of an early operated isolated
VSD at cognitive, psychomotor, emotional and neurobiological levels. Furthermore,
identification of specific predictors for development of affected children was anticipated.
Methods: 39 children (23 girls, 16 boys; age-range: 6;1–7;9 year, M = 7;4, SD = 1;0),
who were operated for a VSD under 3 years of age in the Department of Pediatric Cardiac
Surgery at the University Hospital Erlangen, and their mothers participated in the
study at the Department of Child and Adolescent Psychiatry at the University Hospital
Erlangen. Within a broad examination, child development status as well as mental health
and function of the Hypothalamic–pituitary–adrenal axis of child and mother were assessed
using psychological testing methods, standardized questionnaires and biomarker testing.
All measures were compared to a healthy control group. Additionally, the length of
the surgical scar was measured and characteristics of the VSD surgery and hospitalization
were extracted from the patient chart.
Results: Children with an early corrected VSD showed reduced language skills and elevated
anxiety symptoms compared to the healthy control group. These child impairments could
be mitigated by proactive parenting behavior of a mother with low anxiety symptoms.
Longer hospitalization was associated with lower cognitive and psychomotor performance.
A longer surgical scarce was associated with elevated child anxiety. Age at surgery
and quality of life were inversely correlated (Eichler et al., 2019). Diurnal cortisol
profiles of children with an early corrected VSD did not differ from those of controls;
however, mothers of affected children exhibited higher cortisol levels in the morning
(Stonawski et al., 2018).
Conclusion: Supportive programs should be offered to parents of children with a heart defect
before and after a surgery regarding parenting behavior and mental health. By supporting
the parents, child developmental impairments could be reduced and child and parent
mental health maintained.
Reference
1. Eichler A, Köhler-Jonas N, Stonawski V, et al. Child neurodevelopment and mental
health after surgical ventricular septal defect repair: risk and protective factors.
Dev Med Child Neurol 2019;61(2):152–160 10.1111/dmcn.13992
2. Stonawski V, Vollmer L, Köhler-Jonas N, et al. Long-term associations of an early
corrected ventricular septal defect and stress systems of child and mother at primary
school age. Front Pediatr 2018;5(293):293 10.3389/fped.2017.00293
