• congenital heart disease
• coronary artery disease
• stroke

The adult congenital heart disease (ACHD) population is expanding and ageing. As survival rates of these patients continue to improve, acquired cardiac conditions, such as ischaemic cerebrovascular events and coronary artery disease (CAD), are likely to gain importance.1 However, limited information about the spectrum and the mechanisms of these conditions is available.

With regard to stroke, patients with ACHD are at a low absolute, yet a relative high risk compared with the general population. A retrospective analysis of 29 638 patients from Quebec showed that 1 in 11 men and 1 in 15 women between 18 and 64 years of age had a history of a stroke.2 In Euro Heart Survey on ACHD, in which the inclusion of patients with more complex lesions was quite high, 4% of 4168 patients experienced a cerebrovascular accident or transient ischaemic attack (TIA).3 In the Swedish Patient Registry of congenital heart disease, 0.5% of patients experienced an ischaemic stroke.4 A very low incidence was also found by Bokma et al, who reported that 56 out of 6904 patients had a history of ischaemic stroke/TIA.5 However, it should be taken into account that although population-based studies are of high importance, there are limitations inherited with this type of studies, as some details in the medical records cannot be adequately accessed. Jensen et al showed that in a cohort of 98 patients with cyanotic ACHD, findings consistent with previous stroke diagnosed with a brain MRI were reported in 47% of patients, while only 21% had a known medical history of a stroke, indicating the significant under-reporting and the high prevalence of ‘silent’ cerebrovascular events …