Article

The woman with congenital heart disease

01/1998; DOI: 10.1053/euhj.1998.1204
Source: OAI
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    ABSTRACT: To determine styles of coping, that is personal ways of dealing with problems, and social support, or support from the social environment, in a cohort of adults with congenital heart disease. We subjected 362 patients with congenital heart disease, aged from 20 to 46 years, belonging to five diagnostic groups, to extensive medical and psychological examination from 20 to 33 years after their first open heart surgical procedure. During psychological examination, 342 patients filled in questionnaires concerning styles of coping, specifically the Utrecht Coping List, and social support, using the Social Support List. Overall, styles of coping in the total sample are comparable to those of peers in the general population, except for lower active problem solving, which can be attributed to female patients. Males with congenital heart disease showed more favourable styles of coping compared to their peers, such as higher seeking of social support, lower passive reaction patterns, and lower expression of negative emotions. Compared to the reference group, the total cohort of patients reported to receive less social support, but also to experience less discrepancies between desired and received social support, indicating feelings of independence in these adults. Females with congenital heart disease were found to seek and receive more social support compared to their male counterparts. Overall, few differences in styles of coping were found between the patients and their reference groups. Perceived social support in the sample of patients was favourable.
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    ABSTRACT: To identify the causes of death and main cardiovascular complications in adolescents and adults with congenitally malformed hearts. Retrospective review of 102 necropsy reports from a tertiary centre obtained over a period of 19 years. The diagnosis, the operated or non-operated state of the main defect, the cause of death, and main complications were related to the age and gender. Other clinically relevant conditions, and identifiable sequels of previous diseases, were also noted. The ages ranged from 15 to 69 years, with a mean of 31.1 and a median of 28 years, with no difference detected according to the gender. Of the patients, two-thirds had been submitted to at least one cardiac surgery. The mean age of death was significantly higher in non-operated patients (p = 0.003). The most prevalent cause of death in the whole group was related to recent surgery, found in one-third. From them, two-fifths corresponded to reoperations. Among the others, cardiac failure was the main terminal cause in another third, and the second cause was pulmonary thromboembolism in just over one-fifth, presenting a significant association with histopathological signs of pulmonary hypertension (p = 0.011). Infection was the cause of death in 7.8% of the patients, all previously operated. Acute infective endocarditis was present or was the indication for the recent surgery in one-tenth of the patients, this cohort having a mean age of 27.8 years. There was a statistically significant association between the occurrence of endocarditis and defects causing low pulmonary blood flow (p = 0.043). Data derived from necropsies of adults with congenital heart defects can help the multidisciplinary team refine both their diagnosis and treatment.
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    ABSTRACT: The growing population of adults with congenital heart disease has resulted in the need for focused attention on female reproductive issues. Risk stratification is necessary to evaluate the safety of different contraceptive methods in these complex patients. Comprehensive patient education and counseling should begin in adolescence, focusing on the issues of menstruation, sexual activity, and contraception. Lines of communication should be kept open between the patient and their cardiologist or nurse specialist, so that individual contraceptive needs can be addressed on an ongoing basis. With few exceptions, modern hormonal contraception is safe for women with congenital heart disease, and carries many non-contraceptive benefits. If side effects or thromboembolic risks prohibit this form of contraception, then combined barrier methods, intrauterine devices, or sterilization can provide exceptional protection against pregnancy in properly screened patients.
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