New Guidance on Neurodevelopment Outcomes in Patients with Heart Defects

Major strides in medical advances over the past decade have reshaped our understanding of the challenges faced by patients who have experienced congenital heart defects, particularly in terms of neurological development, learning, emotions, and behaviors across their lifespan. A recent scientific statement by the American Heart Association (AHA), published in the journal Circulation, underscores the need for updated guidance in identifying individuals at high risk for neurodevelopmental delays or disorders and outlines strategies to evaluate and manage these challenges. 

Congenital heart defects, the most prevalent birth defects globally, pertain to structural abnormalities in the heart or nearby blood vessels that manifest before birth. While treatment advancements have enabled over 90 percent of individuals with congenital heart defects in developed countries to reach adulthood, the risk of neurodevelopmental issues, especially in severe cases, remains a concern. 

The updated AHA statement serves as a resource for healthcare professionals, which offers insights into categorizing an individual's risk level and considering various factors that affect neurodevelopmental risk. Genetic variants, responsible for nearly one-third of congenital heart defect cases, are among the highlighted risk factors. Additionally, the report identifies emerging risks, such as abnormal placental development and prolonged exposure to anesthesia or neurotoxic chemicals. 

Key points from the new guidance include: 

• Neurodevelopmental difficulties are common among individuals with congenital heart disease and can impact various aspects of life, such as school performance, work, and social interactions. 
• The report categorizes individuals into different risk levels based on factors, like genetic variants affecting heart and brain development, abnormal placental development, and exposure to anesthesia or neurotoxic chemicals. 
• It emphasizes the importance of neuroprotective strategies, early detection of heart defects, monitoring blood flow to the brain, and evaluating and treating neurodevelopmental delays at different life stages. 
• Future priorities include reducing barriers to accessing neurodevelopmental support services, increasing research funding, and improving outcomes for individuals with congenital heart disease. 

Patients with heart defects are at risk for various neurodevelopmental challenges that can impact their learning, emotions, and behaviors across their lifespan. Some of the key neurodevelopmental challenges faced by individuals with congenital heart disease include: 

• Developmental Delays: Patients with congenital heart disease may experience developmental delays, ranging from hypotonia, or low muscle tone, in infancy to persistent delays affecting language, social skills, and feeding. These delays can impact various aspects of development and may become more apparent as the child grows. 
• Learning Difficulties: Children with congenital heart disease may face challenges in school, including difficulties with organization, visuospatial skills, memory, mathematics, and language. Some children may also struggle with social skills, anxiety, depression, and attention deficit hyperactivity disorder, such as ADHD.Neuropsychological Deficits: The new scientific statement highlights a section on the management of neuropsychological deficits in adults with congenital heart disease. This suggests that individuals with heart defects may continue to face cognitive and behavioral challenges into adulthood. 
• Impact on Health-Related Quality of Life: Neurodevelopmental difficulties can affect a person's ability to function well at school, work, or with peers and can impact health-related quality of life throughout childhood and into adulthood. These challenges can have enduring implications for individuals with congenital heart disease. 

By understanding these neurodevelopmental challenges associated with congenital heart disease, healthcare providers can tailor interventions and support services to enhance the overall quality of life for patients across their lifespan. 

References  

American Heart Association News brings you the latest information about congenital heart defects. www.heart.org. February 23, 2024. Accessed February 28, 2024. https://www.heart.org/en/news/tag-congenital-heart-defects. 

Latest research redefines neurodevelopmental risks, outcomes for congenital heart disease. American Heart Association. Accessed February 28, 2024. https://newsroom.heart.org/news/latest-research-redefines-neurodevelopmental-risks-outcomes-for-congenital-heart-disease.