Adults With Complex Congenital Heart Disease: Cerebrovascular Considerations for the Neurologist

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Decreased mortality in congenital heart disease (CHD) leads to a growing adult population.
• Adults with congenital heart disease (ACHD) have increased risks of stroke, silent brain infarcts, and vascular cognitive impairment.
• Complex cardiac lesions significantly elevate the risk of cerebrovascular insults.

Purpose of the Study:

• To review evidence on stroke prevention in ACHD.
• To identify knowledge gaps in cerebrovascular disease management for ACHD patients.
• To raise awareness among adult neurologists regarding ACHD-related neurological risks.

Main Methods:

• Literature review of existing evidence on primary and secondary stroke prevention in complex congenital heart disease.
• Analysis of risk factors contributing to cerebrovascular disease in ACHD.
• Identification of areas requiring further research.

Main Results:

• ACHD patients exhibit elevated risks of stroke and subclinical cerebrovascular disease.
• Both structural cardiac issues and conventional vascular risk factors (hypertension, impaired glucose metabolism) contribute to neurological risks.
• Complex cyanotic heart disease poses the greatest risk.

Conclusions:

• Adult neurologists need to be aware of the significant cerebrovascular risks in ACHD patients.
• Further research is crucial for stroke prevention and acute stroke treatment in this population.
• Management strategies should address both cardiac and conventional vascular risk factors.