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Arterial ischemic stroke in children with cardiac disease
Hiroko Asakai1, Michael Cardamone1, Darren Hutchinson1
1From the Department of Neurology (M.C., B.S., M.T.M.), Royal Children's Hospital, Murdoch Childrens Research Institute, and the Department of Paediatrics, University of Melbourne; Department of Cardiology (H.A., D.H., M.M.H.C.), Royal Children's Hospital, Heart Research Group, Murdoch Childrens Research Institute, and the Department of Paediatrics, University of Melbourne; and the Clinical Epidemiology and Biostatistics Unit (J.C.G.), Murdoch Childrens Research Institute, and the Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.
Insights
Children with heart conditions are at risk for arterial ischemic stroke (AIS), especially after cardiac procedures. Cyanotic congenital heart disease poses the highest risk for periprocedural AIS, necessitating further research into prevention strategies.
Area of Science:
- Pediatric Cardiology
- Pediatric Neurology
- Vascular Neurology
Background:
- Arterial ischemic stroke (AIS) is a serious complication in children with cardiac disease.
- Understanding the relationship between cardiac disorders, interventions, and AIS is crucial for improving patient outcomes.
Purpose of the Study:
- To delineate the spectrum of cardiac disorders associated with AIS in children.
- To determine the timing of AIS in relation to cardiac interventional procedures.
- To evaluate the outcomes of children experiencing AIS with underlying cardiac conditions.
Main Methods:
- Retrospective study of children (<18 years) with cardiac disease and confirmed AIS.
- Data collected from Royal Children's Hospital Melbourne (1993-2010) using ICD-9/ICD-10 codes.
- Analysis of cardiac diagnoses, procedural history, stroke timing, and patient outcomes.
Main Results:
- 76 children with cardiac disease and AIS identified; median age 5 months.
- Cyanotic congenital heart disease (CHD) was the most common cardiac lesion (55%).
- AIS occurred post-procedure in 68% of cases (41 post-surgery, 11 post-catheterization); 1% incidence in cyanotic CHD palliative surgery.
- 84% of survivors had persistent neurologic deficits.
Conclusions:
- Infants with cyanotic CHD are most vulnerable to periprocedural AIS.
- The periprocedural period is a critical time for AIS development in this population.
- Further prospective studies are needed to establish effective primary and secondary prevention strategies for AIS in pediatric cardiac patients.
Objective:
To describe the spectrum of cardiac disorders, timing in relation to interventional procedures, and outcome in children with cardiac disease and arterial ischemic stroke (AIS).
Methods:
Children younger than 18 years with cardiac disease and radiologically confirmed AIS admitted to the Royal Children's Hospital Melbourne between 1993 and 2010 were retrospectively identified using ICD-9 and ICD-10 searches.
Results:
Seventy-six children with cardiac disease and radiologically confirmed AIS were identified with the median age at diagnosis of 5 months (interquartile range 0-58). Cardiac lesions included cyanotic congenital heart disease (CHD) in 42 (55%), acyanotic heart disease in 24 (29%), cardiomyopathies/myocarditis in 6 (8%), infective endocarditis in 3 (4%), and primary arrhythmias in 3 (4%). Stroke occurred following cardiac procedures in 52 patients (68%): 41 post cardiac surgery (4.6 strokes per 1,000 surgical procedures) and 11 post cardiac catheterization (1.7 strokes per 1,000 catheterizations). The median time from procedure to diagnosis of stroke was 3 days (interquartile range 2-7), with 68% (95% confidence interval 58%-79%) of strokes estimated to occur within the periprocedural period. Prevalence of periprocedural stroke varied by diagnostic category, but was most common in patients with cyanotic CHD undergoing palliative surgery (22/2,256, 1%) (p < 0.005). There were 3 AIS-related deaths, and 54 survivors (84%) had persisting neurologic deficits.
Conclusions:
Infants with cyanotic CHD were most frequently affected by AIS during the periprocedural period. Prospective cohort studies are required to determine effective primary and secondary prevention strategies.
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