Cerebrovascular accidents in adult patients with congenital heart disease.

Abstract

OBJECTIVE:

To investigate the prevalence and characteristics of cerebrovascular accidents (CVA) in a large population of adults with congenital heart disease (CHD).

METHODS AND RESULTS:

In a retrospective analysis of aggregated European and Canadian databases a total population of 23 153 patients with CHD was followed up to the age of 16-91 years (mean 36.4 years). Among them, 458 patients (2.0%) had one or more CVA, with an estimated event rate of 0.05% per patient-year. Permanent neurological sequelae were noted in 116 patients (25.3%). The prevalence of CVA in selected diagnostic categories was as follows: open atrial septal defect 93/2351 (4.0%); closed atrial or ventricular septal defect 57/4035 (1.4%); corrected tetralogy of Fallot 52/2196 (2.4%); Eisenmenger physiology 24/467 (5.1%); other cyanotic 50/215 (23.3%); mechanical prostheses (29/882 (3.3%). Associated conditions in patients with CVA were absence of sinus rhythm (25%), transvenous pacemakers (7%), endocarditis (2%), cardiac surgery (11%) and catheter intervention (2%), but with the exception of absent sinus rhythm these were not significantly more prevalent in patients with CVA.

CONCLUSION:

CVA are a major contributor to morbidity in this young population despite absence of classical cardiovascular risk factors. Although the prevalence of CVA in patients with CHD appears low, it is 10-100 times higher than expected in control populations of comparable age. Residua occur in a strong minority of patients. The subjects at highest risk are those patients with CHD with cyanotic lesions, in whom the prevalence is over 10-fold above the average.

• Authors: A Hoffmann, P Chockalingam, O H Balint, A Dadashev, K Dimopoulos, R Engel, M Schmid, M Schwerzmann, M A Gatzoulis, B Mulder, E Oechslin
• Journal: Heart (British Cardiac Society) (Heart) Vol. 96 Issue 15 Pg. 1223-6 (Aug 2010) ISSN: 1468-201X [Electronic] England
• PMID: 20639238 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Child
• Child, Preschool
• Epidemiologic Methods
• Europe (epidemiology)
• Female
• Heart Defects, Congenital (complications, epidemiology, surgery)
• Humans
• Infant
• Male
• Middle Aged
• Ontario (epidemiology)
• Stroke (epidemiology, etiology)