الفهرس 
CONGENITAL HEART DEFECTSOnly 14 pages are availabe for public view
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Abstract
S
urvival of infants born with congenital heart disease (CHD) is improving tremendously and although most of them have mild lesions, others may be considered as only being palliated and undergo many medical or surgical interventions. Patients with CHD will be exposed to the same problematic of the modern lifestyle such as increased prevalence of obesity, decreased physical activities and exposure to smoking which leads to acquired cardiovascular disease.
The aim of work is to determine the risk factors and outcomes of cerebrovascular accidents that occur either spontaneously or peri-procedurally in children with congenital heart disease.
To elucidate this aim, 72 patients collected from the patients’ files at the Pediatric Neurology Clinic, and Pediatric Cardiology Clinic, Children’s Hospital, Cardiothoracic Surgery Academy, Radio diagnosis Departments, Faculty of Medicine, Ain Shams University Hospitals with age ranged from 2 months to 18 years were enrolled in the study.
The main results:
• In case group, they were 12 females (40%) and 18 males (60 %), 29 females (69%) and 13 males (31%) in the control group.
• The age at diagnosis of CVA in case group ranged from (2 months to 1 year) in 17 patients (56.7%) , (2 – 6 years) in 7 patients (23.3%), and (7 – 12 years) in 3 (10.0%),and (13 – 18 years) in 3 (10.0%). Males in patients with stroke (60.0%) than in patients without stroke (31.0%) with p-value = 0.014.
• Twenty-four (57.1%) without stroke and 15 (50.0%) with stroke had acyanotic cardiac disease with the most common being VSD in 7 (23.3%) of those with stroke.
• In the current study, 21 (70%) out of 30 patients was diagnosed as arterial ischemic stroke (AIS), 2(6.7%) cerebral venous sinus thrombosis (CVST), and 7(23.3%) hemorrhagic stroke.
• The incidence of CVA was post therapeutic cardiac catheterization in 5 patients out of 30(16.6%), pre-operative in 2 patients (6.6%) and postoperative in 23 patients (76.6%)
• As regard risk factors, the most common risk factors were ischemia either surgical or non surgical related in 37 patients (51.3%) out of 72 [23 out of 30 patients in case group (76.6%)], followed by high blood pressure at admission in 12 patients (16.7%), and hypoperfusion in 7 patients (9.7%).
• In the present study, the most common clinical presentation was seizures in 15 patients (50%), disturbed conscious level (DCL) in 15 patients (50%) and limb weakness in 12 patients out of 30 (40%).
• According to the imaging modalities, CT brain only was done in 1 patient (3.3%), MRI stroke protocol was done in 22 patients (73.3%), and both of them was done in 7 patients (23.3%).
• As regard to affected lobe, the most common affected lobe in the current study was mixed in 16 patients (55.2%) followed by parietal lobe in 9 (31.0%) patients.
• According to the vascular involvement, the most common vascular involvement was MCA (14)48.3% followed by ICA (5)17.2%, and transverse (5)17.2%. Presence of hemorrhage was seen in 13.8%.
• As regard to location of stroke, anterior circulation (23) 79.3% was the most common site, multiple vessels affected in 5 (17.2%) patients.
• There was statistically significant decrease in age at time of CVA in patients with stroke than patients without stroke. There was no statistically significant difference found between patients with and without stroke regarding cardiac cyanotic and acyanotic cardiac diagnosis.
• That there was statistically significant association found between occurrence of stroke and male gender,, age at time of cerebrovascular accident less than 7 years, weight less than or equal to 11 kg, ischemia, hypoperfusion, high blood pressure at admission, aortic cross clamping time, cardiopulmonary bypass time, duration of surgery more than 5hours.
CONCLUSION
The present study concluded that:
• Our results suggest that patients with CHD were most frequently affected by AIS peri-procedurally (70%).
• Risk factors for stroke included male gender, age at time of CVA younger than 7 years, weight less than or equal to 11 kg, ischemia, hypoperfusion, high blood pressure at admission, aortic cross clamping time, cardiopulmonary bypass time, duration of surgery more than 5 hours.
• Individuals with CHD are at a higher risk of CVA, and this suggests that the risk assessment for CVA based on conventional cardiovascular risk factors should be considered in these patients.
• Preventive measures as preventing of dehydration, treatment of any febrile illness and start of antiplatelet in high risk group should be started early.
RECOMMENDATIONS
from the current study we recommend that:
• Further research is needed to better understanding of the risk factors and outcomes of cerebrovascular accidents, that occur either spontaneously or peri-procedurally in children with congenital heart disease.
• With advances in surgical and catheter procedures and novel anticoagulation agents, systematic research protocols are important to identify targets for stroke prevention.
• Multicenter studies are required to improve outcomes in this complex patient population.