Multidisciplinary Evaluation of Heart Transplantation and Ventricular Assist Device Implantation in a Child with Autism Spectrum Disorder
Makaleler > Tam Makale · 2024
Yazarlar: Nurhak DOĞAN, Nazlı Burcu ÖZBARAN, Didem Cek Ozturk, Oguzhan Ay, Zulal Ulger Tutar, Mustafa ÖZBARAN
Archives of Neuropsychiatry, Uluslararası, Wos, 2024, cilt 61, ss 377-379
DOI: 10.29399/npa.28647
Özet
The number of heart transplantations in Türkiye has been increasing steadily since 1996.Ventricular assist device (VAD) works as a bridge while patients with advanced heart failure wait for a heart transplant.VADs are mechanical pumps that support the heart and blood flow in patients with poor heart function.VADs use a hydrodynamic centrifugal pump with a short inlet cannula that is placed intracorporeally in the pericardium at the apex of the ventricle, and is connected to the external unit and batteries with the help of a cable.The cannula design and the small size of the device facilitate intrapericardial placement.Patients carry this device with them in a 30×45 cm bag with two replaceable batteries and a main box with a screen.Thus, they are no longer confined to bed and hospital dependence is reduced.Patients should be able to monitor the screen to constantly check the battery level and alarms, and this bag and the cables coming out of the bag must be constantly protected.Post-surgical anticoagulant treatment is started in patients implanted with VADs and the International Normalized Ratio (INR) is checked every week.Furthermore, patients undergo physical examination, echocardiography and psychiatric evaluations every month.All family members receive training on device functions, problem-solving methods, wound dressing, and possible complications of anticoagulant therapy (1).In addition to protecting the device, patients and families also need to watch out for situations such as accidental blows to the body and minor injuries due to possible complications of anticoagulant therapy.The council decided that the case was suitable for heart transplantation but not suitable for long-term intracorporeal device implantation due to behaviors such as plucking wounds, playing with vascular access, and being nervous about vascular access.The council stated that due to sensory hypersensitivity of the case, implantation of such a device may further increase anxiety, and involuntary damage to the device may result in personal harm.We hope that this case report will guide future endeavors to develop devices suitable for cases with ASD or other behavioral problems.