Risk of stroke in adults with cyanotic congenital heart disease.

Perloff, Joseph K.; Marelli, Ariane J.; Miner, Pamela D.

doi:10.1161/01.cir.87.6.1954

Cited by 152 publications

(90 citation statements)

References 33 publications

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“…The literature is ambiguous, however, on the thrombotic risk of hyperviscosity, indicating the necessity of further investigation. [33][34][35][36] A limitation of the present study was the small difference in IMT between two small and relatively young groups. The IMT was within the normal range 37 and both groups would be estimated to be at low risk for cardiovascular event.…”

Section: Duffels Mgj Et Almentioning

confidence: 80%

Atherosclerosis in Patients With Cyanotic Congenital Heart Disease

Duffels

Mulder

Trip

et al. 2010

Circ J

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Background: Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. Methods and Results:Atherosclerotic risk factors and carotid intima -media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age- and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81±6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55±0.1 mm vs 0.58±0.08 mm: ∆IMT =0.04 mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4±1 mmol/L vs 4.9±1 mmol/L; P=0.02), as well as lower thrombocyte levels (173±81×10 9 /L vs 255±54×10 9 /L; P<0.01), higher bilirubin levels (18.6±11 μmol/L vs 12.7±6 μmol/L; P<0.01), and lower diastolic and systolic blood pressure (71±9 mmHg vs 76±9 mmHg, P<0.01; 113±14 mmHg vs 124±12 mmHg, P<0.01, respectively). Conclusions:In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels. (Circ J 2010; 74: 1436 - 1441

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Section: Duffels Mgj Et Almentioning

confidence: 80%

Atherosclerosis in Patients With Cyanotic Congenital Heart Disease

Duffels

Mulder

Trip

et al. 2010

Circ J

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“…The methods to assess viscosity used in each study were different and may contribute to the different results. It also should be mentioned that the pathophysiological role of iron deficiency in stroke in secondary erythrocytosis from CCHD has been questioned [35].…”

Section: Discussionmentioning

confidence: 99%

Hydroxyurea therapy for management of secondary erythrocytosis in cyanotic congenital heart disease

et al. 2007

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Secondary erythrocytosis in cyanotic congenital heart disease (CCHD) causes substantial morbidity because of complications of hyperviscosity, including stroke and chronic end organ damage. Phlebotomy provides temporary improvement but leads to iron deficiency and can actually increase blood viscosity. We describe the successful use of hydroxyurea (hydroxycarbamide) in four patients with uncorrected CCHD and symptomatic secondary erythrocytosis. In all patients, hydroxyurea improved symptoms of hyperviscosity. Substantial decreases in the red blood cell (RBC) count were observed, along with increases in the mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH), leading to only modest declines in the circulating hemoglobin concentration. Two patients experienced transient mild myelosuppression, which promptly resolved with dose reduction of hydroxyurea. Hydroyxurea provides a novel and useful therapeutic approach to reduce hyperviscosity from secondary erythrocytosis in patients with CCHD, while preserving oxygen carrying capacity and avoiding iron depletion by phlebotomy. Am. J. Hematol. 82:740-743, 2007. V

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“…A Ht of > 70% could induce coagulopathy, which is assumed to be associated with an increased risk of cerebral stroke [35−37]. However, phlebotomy is not warranted to reduce this assumed risk of stroke [35,36]. The hyperviscosity can worsen as a result of a too long fasting period or as a result of insufficient intraoperative infusion therapy.…”

Section: Consequences Of Chronic Hypoxiamentioning

confidence: 99%

Anaesthesia management for non-cardiac surgery in children with congenital heart disease

Yamamoto¹,

Schindler²

2016

Anaesthesiol Intensive Ther

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Congenital heart disease (CHD) is the most common form of congenital abnormality and occurs in over 1% of newborns. Approximately 30% of children with CHD have other extra-cardiac anomalies, which significantly increases mortality in CHD patients. It is expected that the number of CHD patients who consult non-specialized hospitals for non-cardiac surgery after palliative or corrective operations will increase because of the extraordinary progression of treatments, such as surgical procedures, interventional procedures, and intensive care medicine, as well as diagnosis. The aim of this article is to enable anaesthesiologists who are not usually engaged in the anaesthesia management of CHD patients to provide perioperative management for CHD patients safely and with confidence by having basic and advanced knowledge about CHD patients and their pathophysiological characteristics. Anestezjologia Intensywna Terapia 2016, tom 48, nr 5, 320-328Key words: anaesthesia, children, congenital heart diseases, extra-cardiac anomalies, Fontan and hemi-Fontan circulation, Ohm's law, pulmonary vascular resistance Congenital heart disease (CHD) is the most common form of congenital abnormality and occurs in over 1% of newborns [1]. This frequency is much higher than expected and is still constant regardless of the continuous progression of prenatal diagnosis [2,3]. In addition to the diagnosis, treatments such as surgical procedures [4−7], interventional procedures [8,9], and intensive care medicine [10] have made extraordinary progress in the past several decades. CHD patients tend to have palliative or corrective operations younger than before [11], and the prognoses, especially in the patients with more complicated CHD, have improved markedly [12,13]. Therefore, it is expected that the number of CHD patients who consult non-specialized hospitals for non-cardiac surgery after palliative or corrective operations will increase. Indeed, it has been reported that the risk of perioperative cardiac arrest is higher in CHD children [14]. Although the frequency of perioperative complications for non-cardiac surgery in CHD patients who have no preoperative complications such as pulmonary hypertension, congestive heart failure, or cyanosis, has been reported to be as low as the frequency in non-CHD patients [15], recent cohort studies have reported that CHD patients who were undergoing non-cardiac surgery exhibited increased perioperative morbidity and mortality [16,17]. The aim of this article is to enable anaesthesiologists who are not usually engaged in anaesthesia management for CHD patients to provide perioperative management for CHD patients safely and with confidence by having basic and advanced knowledge about CHD patients and their pathophysiological characteristics [18].

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Risk of stroke in adults with cyanotic congenital heart disease.

Cited by 152 publications

References 33 publications

Atherosclerosis in Patients With Cyanotic Congenital Heart Disease

Atherosclerosis in Patients With Cyanotic Congenital Heart Disease

Hydroxyurea therapy for management of secondary erythrocytosis in cyanotic congenital heart disease

Anaesthesia management for non-cardiac surgery in children with congenital heart disease

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