title: Psychological adjustment and quality of life in children and adolescents following open-heart surgery for congenital heart disease: a systematic review.
abstract: BACKGROUND
  Children with congenital heart defects (CHD) requiring open-heart surgery are a group at high risk for health-related sequelae. Little consensus exists regarding their long-term psychological adjustment (PA) and health-related quality of life (QoL). Thus, we conducted a systematic review to determine the current knowledge on long-term outcome in this population.
  
  
  METHODS
  We included randomized controlled trials, case control, or cohort studies published between 1990-2008 evaluating self- and proxy-reported PA and QoL in patients aged between two and 17 years with a follow-up of at least two years after open heart surgery for CHD.
  
  
  RESULTS
  Twenty-three studies assessing psychological parameters and 12 studies assessing QoL were included. Methodological quality of the studies varied greatly with most studies showing a moderate quality. Results were as follows: (a) A considerable proportion of children experienced psychological maladjustment according to their parents; (b) studies on self-reported PA indicate a good outcome; (c) the studies on QoL suggest an impaired QoL for some children in particular for those with more severe cardiac disease; (d) parental reports of psychological maladjustment were related to severity of CHD and developmental delay.
  
  
  CONCLUSIONS
  A significant proportion of survivors of open-heart surgery for CHD are at risk for psychological maladjustment and impaired QoL. Future research needs to focus on self-reports, QoL data and adolescents.
authors.affiliation: University Children's Hospital Zurich, Department of Psychosomatics and Psychiatry, Steinwiesstrasse 75, Zurich, Switzerland. bea.latal@kispi.uzh.ch
authors.forename: Beatrice
authors.initials: B
authors.lastname: Latal
authors.forename: Susanne
authors.initials: S
authors.lastname: Helfricht
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome