Neurologic Disorders

Risk Factors for Thrombosis in Children with Cyanotic Congenital Heart Disease

“…Our study showed that 35% of patients with CCHD enrolled during the study period had a history of thrombotic event. Other authors [6] reported that in patients with CCHD less than 4 years old, the risk for cerebrovascular thrombosis is increased, with the incidence varies from 1.6 to 20%. Silversides et al [7] denoted a pulmonary artery thrombus in 21% of patients with Eisenmenger syndrome.…”

“…By contrast, other authors [19] reported that iron deficiency may contribute to a hypercoagulable state by many mechanisms including; affection of the blood flow patterns within the vessels due to reduced deformability and increased viscosity of the resulting microcytic red cells, decrease in the antioxidant defense with increase in oxidant stress which may result in a tendency towards platelet aggregation, as well as the secondary thrombocytosis attributed to the release of the inhibitory effect on thrombopoiesis maintained by normal iron levels; the latter not being the case in our patients. Moreover, iron-deficient erythrocytosis in patients with CCHD less than 4 years old was reported to predispose cerebrovascular thrombosis in the intracranial venous sinuses [6] . Although the precise mechanisms for the hypercoagulable state existent in CCHD are still not fully clarified and are proposed to be multifactorial, yet this study explicitly addressed, helped understanding and provided further insights on the role for the proposed risk factors for thrombosis in children with CCHD, as well as assessed the potential role for TM as a novel risk factor.…”

Pregnancy in Patients with Tetralogy of Fallot

“…In addition to hemodynamic changes of pregnancy that worsen right to left shunting and have the potential to increase cyanosis, these patients are also more likely to have liver and renal impairment, coagulopathy, neurological insult, and structural lung disease. [10][11][12] In a prospective study of completed pregnancies in 599 patients with heart disease, Siu and colleagues determined 4 risk factors associated with the development of cardiac complications (cardiac death, stroke, pulmonary edema, or arrhythmia) during pregnancy, including poor functional class (New York Heart Association functional class III or IV) or cyanosis, left ventricular dysfunction, left heart obstruction, and presence of a cardiac event prior to pregnancy (arrhythmia, stroke, transient ischemic attack, or pulmonary edema). From these risk factors, a risk index was determined, suggesting the risk of cardiac complications in patients with no prior risk factors to be about 5%, increasing to 25% in patients with one risk factor and significantly increasing to 75% in those with more than one risk factor.…”