Letter to the Editor Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(3) 374 ß The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492313493427 aan.sagepub.com

Nonpsychotic mental disorder after open heart surgery I read with great interest the article by Okamoto and colleagues1 on anxiety and depression in patients after thoracic aortic surgery (TAS) compared to coronary artery bypass grafting. I congratulate Okamoto and coworkers on their well-designed analysis and the interesting results in their publication. They concluded that TAS patients have some anxiety and depression 1–5 years after surgery, similar to coronary artery bypass patients. They did not find any variable related to anxiety in TAS patients, but some related to depression. In coronary artery bypass patients, some variables were related to both anxiety and depression. Neuropsychological and psychopathologic changes following open heart surgery have been recognized from the very beginning of modern heart surgery. Variables correlated with nonpsychotic mental disorder after cardiac surgery must be divided into pre-, intraand postoperative. Older age, personality trait, history of drug or alcohol dependence, severity and length of symptoms as well as emergency intervention are important factors in the preoperative time assessment influencing nonpsychotic mental disorder after heart surgery. Intraoperative factors are related to the type of operation and technical aspect of the procedure (micro or macro embolic event, duration of extracorporeal circulation, cerebral perfusion technique, and depth of hypothermia). In the postoperative period, the duration of intubation, intensive care unit stay, and related variables (sleep or sensory deprivation, or hyperstimulation) are identified as significant predictors of neuropsychological and psychopathological alterations.2 The incidence, phenomenology, and duration of symptoms diverge from patient to patient, and are difficult to define. One wonders whether any of the patients in either group in this analysis underwent any mechanical cardiac valve replacement. If so, one has to

consider Skumin syndrome, described by Skumin in 1978 as a ‘‘cardioprosthetic psychopathological syndrome’’ associated with mechanical heart valve implant and manifested by irrational fear, anxiety, depression and sleep disorder’’.3 The authors did not find any variable related to anxiety in TAS patients, but some related to depression. This raises the question of how is it possible that patients in the TAS group did not have any anxietyrelated symptoms due to emergency surgery or dissection. Furthermore, one must question why the severity of the presentation of an aortic dissection or emergency surgery did not psychologically affect the patient. I suggest the use of some of the variables I mentioned above in future analysis. References 1. Okamoto Y, Motomura N, Murashima S and Takamoto S. Anxiety and depression after thoracic aortic surgery or coronary artery bypass. Asian Cardiovasc Thorac Ann 2013; 21: 22–30. 2. Walzer TA and Herrmann M. Neuropsychological and psychopathologic changes following cardiac surgical procedures. Fortschr Neurol Psychiatr 1998; 66: 68–83. 3. Bendet IaA, Morozov SM and Skumin VA. Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects. Kardiologiia 1980; 20: 45–51.

Andrea Ruzza Cedars Sinai Medical Center, Los Angeles, California, USA Corresponding author: Andrea Ruzza, MD, PhD, Room 2S04C Saperstein Critical Care Tower, Division of Cardiothoracic Surgery, Cedars-Sinai Heart-Institute, Cedars Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, USA. Email: [email protected]

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Nonpsychotic mental disorder after open heart surgery.

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