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Abstract WMP99: Major Causes of Stroke in Children With Congenital and Acquired Heart Disease

Authors :
Jorina Elbers
Esther J Lee
Vamsi V Yarlagadda
Clara Lo
Debra Hanisch
Aileen Lin
Christopher S Almond
Andrew Y Shin
Source :
Stroke. 47
Publication Year :
2016
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2016.

Abstract

Introduction: Heart disease is the leading cause of stroke in children; however, little is known about the distribution of cardiac conditions associated with stroke. Hypothesis: We assessed the hypothesis that patients requiring cardiac surgery, catheterization, or mechanical support account for the majority of strokes in children with heart disease. Methods: All patients admitted to Lucile Packard Children’s Hospital at Stanford were included. A new diagnosis of stroke was identified using hospital data. Descriptive statistics were used to evaluate the characteristics of the population and tabulate common causes of stroke and stroke sub-types. Results: Between September 1, 2009 and February 1, 2014, a total of 36 patients with congenital or acquired heart disease had a new diagnosis of stroke. The median age was 4.18 years (IQR 0.32 - 10.6 years); 64% were male. Overall, 50% of strokes were arterial ischemic, 17% hemorrhagic and 25% had both ischemic and hemorrhagic components. Transient ischemic attacks accounted for the remaining 8%. Patients on mechanical support accounted for the majority of strokes (33%; ECMO 22%, ventricular assist device 11%) followed by left-sided cardiac catheterization (22%). Single-ventricle palliation procedures (Norwood or Glenn) accounted for 11% and septal defect repair 8%. Associated cardiac conditions included cardiomyopathy (28%), single-ventricle physiology (28%), septal defects (14%), myo/endocarditis (11%), heart transplantation (6%), and left-sided valvular disease (5%). Overall, 47.2% of patients were receiving anticoagulant therapy at the time of their stroke. Among those patients, 32% with arterial ischemic strokes and 60% with hemorrhagic strokes were within goal anticoagulation levels. Conclusions: Mechanical circulatory support, cardiac catheterizations and single-ventricle palliation procedures account for two-thirds of strokes observed in patients with cardiac disease. Many strokes occur in patients receiving anticoagulant therapy in accordance with contemporary anticoagulation guidelines. Re-evaluation of these guidelines and studies to reduce the risk of strokes in vulnerable sub-groups of cardiac patients is warranted.

Details

ISSN :
15244628 and 00392499
Volume :
47
Database :
OpenAIRE
Journal :
Stroke
Accession number :
edsair.doi...........db212bdd3dcb28f46b4acd63e39ae799
Full Text :
https://doi.org/10.1161/str.47.suppl_1.wmp99