Long-term Impact of an Early Operated Ventricular Septal Defect (VSD): Mental Health and Development in Children at Early School Age

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