Cerebrovascular accidents in adult patients with congenital heart disease
- A Hoffmann1,
- P Chockalingam2,
- O H Balint3,
- A Dadashev3,
- K Dimopoulos4,
- R Engel4,5,
- M Schmid6,
- M Schwerzmann6,
- M A Gatzoulis4,
- B Mulder2,7,
- E Oechslin3
- 1University Hospital, Basel, Switzerland
- 2Academic Medical Center, Amsterdam, Netherlands
- 3Toronto Congenital Cardiac Centre for Adults, at Peter Munk Cardiac Centre, University Health Network/Toronto General Hospital, Toronto, Canada
- 4Royal Brompton and the National Heart and Lung Institute, London, UK
- 5Kantonsspital St. Gallen, Switzerland
- 6University Hospital, Inselspital, Bern, Switzerland
- 7University Medical Center Utrecht, Netherlands
- Correspondence to Professor Andreas Hoffmann, Department of Cardiology, University Hospital Basel, Lange Gasse 78, CH-4052 Basel, Switzerland;
- Accepted 6 April 2010
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.
Funding RE was supported by a grant from the Kantonsspital St Gallen/CH.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.