Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

There is a growing population of adults with congenital heart disease(CHD) due to improved survival beyond childhood.It has been suggested that adults with CHD may be at increased risk for mental health problems,particularly depression.The reported incidence of depression in CHD varies from 9% to 30%.This review examines the evidence for a higher depression rate in CHD vs general population.Possible explanations are offered from a variety of disease models,ranging from brain injury to the psychoanalytical approach.Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy,separation from the parents during hospitalizations and brain organic syndromes.Later in life,patients often have to cope with physical limitations.Recent improvements in care may be protective.Current patients may benefit from an earlier age at first surgical intervention,fewer reoperations and inclusion to the mainstream schooling,among other factors.At this point,there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD.Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.

Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

A 15-year-old boy with transposition of the great arteries(TGA) and neonatal arterial switch operation(ASO) presented with complete occlusion of the left main coronary artery(LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram(CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies.