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Cerebellar infarct: late complication of the Fontan procedure?
R L Hutto1, J P Williams, P Maertens
1Department of Radiology, University of South Alabama, Mobile 36689.
Insights
Children with cardiac disease have a higher risk of stroke. This case report details a rare instance of stroke occurring 24 months after the Fontan procedure, the longest reported interval.
Area of Science:
- Pediatric Cardiology
- Neurology
- Cardiovascular Surgery
Background:
- Cardiac disease affects about 30% of children experiencing stroke.
- The Fontan procedure is a surgical intervention for complex congenital heart defects.
- Previous literature indicates stroke risk is highest in the immediate postoperative period following the Fontan procedure.
Observation:
- This report details a case of a child who developed a stroke in the superior cerebellar artery distribution.
- The stroke occurred 24 months after the patient underwent the Fontan procedure.
- This represents the longest documented time between the Fontan procedure and stroke onset.
Findings:
- The patient experienced a cerebral infarction significantly later than typically reported post-Fontan procedure.
- The study discusses potential causes for stroke in patients who have had the Fontan procedure.
- This case highlights a prolonged risk period for stroke after Fontan palliation.
Implications:
- The findings suggest that the risk of stroke after the Fontan procedure may extend beyond the immediate postoperative phase.
- This case underscores the need for continued monitoring of neurological health in Fontan patients.
- Further research is warranted to elucidate the mechanisms and long-term risks of stroke in this population.
Abstract:
Cardiac disease is present in approximately 30% of children with stroke. Other case reports have documented stroke in patients who have previously undergone the Fontan procedure for correction of tricuspid atresia. Most of these strokes have occurred in the immediate postoperative period. There has been one report of a cerebral infarction 3 1/2 months after surgery. We report a child with superior cerebellar artery distribution infarction after undergoing the Fontan procedure 24 months previously. Previous reports of stroke in patients having undergone the Fontan procedure and possible etiologies for these strokes are discussed. We believe our patient had the longest procedure-to-stroke interim yet reported.