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Cerebrovascular accidents following the Fontan operation
A J du Plessis1, A C Chang, D L Wessel
1Department of Neurology, Children's Hospital, Boston, MA 02115, USA.
Insights
The Fontan operation, a common surgery for congenital heart disease, had a 2.6% stroke incidence in survivors. This study details stroke risk factors and timing after this procedure.
Area of Science:
- Pediatric Cardiology
- Neurology
- Congenital Heart Disease
Background:
- The Fontan operation is a frequent surgical intervention for complex congenital heart disease in children.
- While surgical survival has improved, the neurological outcomes following the Fontan procedure remain incompletely understood.
Purpose of the Study:
- To determine the incidence of postoperative cerebrovascular accidents (strokes) in survivors of the Fontan operation.
- To describe the clinical features and risk period for stroke in this patient population.
Main Methods:
- Retrospective review of 645 patients who underwent the Fontan procedure between August 1978 and July 1993.
- Identification and analysis of patients who experienced a stroke post-operatively.
Main Results:
- A total of 17 patients (2.6%) experienced a stroke after the Fontan operation.
- The identified risk period for stroke extended from the first postoperative day up to 32 months following the procedure.
Conclusions:
- The Fontan operation carries a notable risk of postoperative stroke in pediatric patients.
- Further investigation into pre-, intra-, and postoperative factors is warranted to mitigate stroke risk.
Abstract:
The Fontan operation is one of the most common cardiac operations for children with congenital heart disease beyond the first year of age. Although the surgical mortality of this procedure has improved over the past 2 decades, the neurologic outcome in this population is not well described. We performed a retrospective review of 645 patients who underwent the Fontan procedure at Children's Hospital in Boston over the 15-year period between August, 1978 and July, 1993, to describe the incidence of postoperative cerebrovascular accidents or strokes among survivors. We identified 17 patients (2.6%) who suffered a stroke following the Fontan operation. The risk period for stroke in our population extended from the first postoperative day to 32 months after the Fontan procedure. The pre-, intra-, and postoperative clinical features of these patients are described.