Evaluating & Managing Patients With Congenital Heart Disease

Survivors of congenital heart disease (CHD) are at greater risk for neurodevelopmental issues from both biological and environmental risk factors when compared with heart-healthy children. As survival rates in CHD have improved, the focus of clinical research has transitioned from striving for short-term survival to enhancing long-term morbidity. How common is neurodevelopmental impairment? View figure. A New Scientific Statement on CHD In the July 30, 2012 online issue of Circulation, my colleagues and I from the American Heart Association (AHA) released a scientific statement reviewing factors that increase risk for developmental disorders in those with CHD. The statement provides an algorithm for treating these developmental disabilities and stratifies risk; age-based management of CHD patients is also reviewed. The statement also discusses the impact of developmental disorders on quality of life for these individuals. A key recommendation is that children born with CHD should receive early evaluation for related neurodevelopmental disorders. High-risk patients should be referred for further developmental and medical evaluation. Developmental disorders can be identified and managed with continuous surveillance, appropriate screening, early evaluation, periodic reevaluation, and continuous, comprehensive treatment coordinated by a central care provider. Other recommendations include: Establishing a “medical home” to coordinate care between various specialists. Reassessing risk of developmental disorders each time the medical home is visited. Referring high-risk patients with CHD for early interventions before developmental disorders are formally diagnosed. Conducting periodic re-evaluations throughout infancy and childhood at 1 to 2 years, 3 to 5 years, and 11 to 12 years of age for developmental disorders in children with CHD deemed high risk. Considering potential benefits from higher-education or vocational counseling when high-risk...