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Implantation of Total Artificial Heart in Congenital Heart Disease
07:27

Implantation of Total Artificial Heart in Congenital Heart Disease

Published on: July 18, 2014

Total Knee Arthroplasty in the Presence of Congenital Heart Disease: An Under-Recognized Risk

Seyed Morteza Kazemi1, Ava Parvandi1, Amir-Mohammad Asgari1

  • 1Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Arthroplasty Today
|June 15, 2026
PubMed

Insights

Total knee arthroplasty in adults with congenital heart disease, especially with patent foramen ovale or atrial septal defect, can lead to early paradoxical embolic events. Prompt evaluation for intracardiac shunting is crucial for new neurological deficits or hypoxemia.

Area of Science:

  • Cardiology
  • Surgical Outcomes
  • Medical Complications

Background:

  • Adults with congenital heart disease (CHD) are increasingly undergoing noncardiac surgery.
  • Total knee arthroplasty (TKA) poses significant hemodynamic and thromboembolic risks.
  • Intracardiac shunts like patent foramen ovale (PFO) or atrial septal defect (ASD) in TKA patients may cause paradoxical embolism.

Purpose of the Study:

  • To systematically review the complications of TKA in patients with CHD.
  • To identify the incidence and types of paradoxical embolic events.
  • To inform screening and prevention strategies for this high-risk population.

Main Methods:

  • Systematic review adhering to PRISMA guidelines.
  • Searched PubMed, Scopus, Embase, and Web of Science.
  • Included peer-reviewed original studies on TKA outcomes in CHD patients; synthesized findings narratively due to data heterogeneity.

Main Results:

  • Eleven case reports (1996-2023) involving 11 patients were analyzed.
  • PFO (81.8%) and ASD (18.2%) were the most common lesions; neurological symptoms predominated (72.7%).
  • Paradoxical cerebral embolism/stroke was the primary complication, occurring early postoperatively.

Conclusions:

  • TKA in CHD patients, particularly with PFO or ASD, carries a risk of early paradoxical embolic events.
  • New neurological deficits or unexplained hypoxemia necessitate urgent evaluation for intracardiac shunting.
  • Higher-quality studies are required to develop effective screening and prevention protocols.
Abstract

Keywords:
Congenital heart diseaseEmbolic strokeParadoxical embolismPatent foramen ovaleTotal knee arthroplastyTransesophageal echocardiography

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