Stroke in Acquired and Congenital Heart Disease Patients and Its Relationship to Hospital Mortality and Lasting Neurologic Deficits

Cheng, Henry; Rajagopal, Satish; McDavitt, Erica; Wigmore, Daniel; Williams, Kathryn; Thiagarajan, Ravi R.; Grant, P. Ellen; Danehy, Amy; Rivkin, Michael J.

doi:10.1097/pcc.0000000000000902

Cited by 14 publications

(16 citation statements)

References 19 publications

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“…One explanation for this could be that stroke can explain more of the deterioration of functional abilities cases, but is often under-recognised. A recent study from Cheng showed that 41% of stroke diagnosis in children with heart disease was found only on surveillance imaging studies 30 . Similar findings were reported by Bellinger et al; they found that 40% of strokes in adolescents surviving the Fontan were initially missed by clinical assessment alone.…”

Section: Discussionsupporting

confidence: 67%

“…A recent study from Cheng showed that 41% of stroke diagnosis in children with heart disease was found only on surveillance imaging studies. 30 Similar findings were reported by Bellinger et al; they found that 40% of strokes in adolescents surviving the Fontan were initially missed by clinical assessment alone. In children, initial symptoms of stroke are often not clear, 31,32 and children with stroke often "grow into their deficits".…”

supporting

confidence: 82%

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Deterioration of functional abilities in children surviving the Fontan operation

et al. 2018

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Functional abilities are needed for activities of daily living. In general, these skills expand with age. We hypothesised that, in contrast to what is normally expected, children surviving the Fontan may have deterioration of functional abilities, and that peri-Fontan stroke is associated with this deterioration. All children registered in the Western Canadian Complex Pediatric Therapies Follow-up Program who survived a Fontan operation in the period 1999-2016 were eligible for inclusion. At the age of 2 years (pre-Fontan) and 4.5 years (post-Fontan), the Adaptive Behavior Assessment System-II general adaptive composite score was determined (population mean: 100, standard deviation: 15). Deterioration of functional abilities was defined as ⩾1 standard deviation decrease in pre- to post-Fontan scores. Perioperative strokes were identified through chart review. Multivariable logistic regression analysis determined predictors of deterioration of functional abilities. Of 133 children, with a mean age at Fontan of 3.3 years (standard deviation 0.8) and 65% male, the mean (standard deviation) general adaptive composite score was 90.6 (17.5) at 2 years and 88.3 (19.1) at 4.5 years. After Fontan, deterioration of functional abilities occurred in 34 (26%) children, with a mean decline of 21.8 (7.1) points. Evidence of peri-Fontan stroke was found in 10 (29%) children who had deterioration of functional abilities. Peri-Fontan stroke (odds ratio 5.00 (95% CI 1.74, 14.36)) and older age at Fontan (odds ratio 1.67 (95% CI 1.02, 2.73)) predicted functional deterioration. The trajectory of functional abilities should be assessed in this population, as more than 25% experience deterioration. Efforts to prevent peri-Fontan stroke, and to complete the Fontan operation at an earlier age, may lead to reduction of this deterioration.

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Section: Discussionsupporting

confidence: 67%

supporting

confidence: 82%

Deterioration of functional abilities in children surviving the Fontan operation

et al. 2018

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“…Childhood AIS resulting from cardiac disease occurs in the inpatient setting more often than the outpatient setting and involves younger children, with a median age of 6 months to 3 years. [68][69][70][71] These children present with seizures in up to 40% and hemiparesis in 36% to 75% and are clinically covert in 14% to 40%. Braun et al 72 found that cardioembolic stroke may present with abrupt onset compared with a stuttering or fluctuating presentation in children with stroke caused by arteriopathy.…”

Section: Tbd 2019mentioning

confidence: 99%

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Ferriero¹,

Fullerton²,

Bernard³

et al. 2019

Stroke

495

515

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Purpose-Much has transpired since the last scientific statement on pediatric stroke was published 10 years ago. Although stroke has long been recognized as an adult health problem causing substantial morbidity and mortality, it is also an important cause of acquired brain injury in young patients, occurring most commonly in the neonate and throughout childhood. This scientific statement represents a synthesis of data and a consensus of the leading experts in childhood cardiovascular disease and stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee and were chosen to reflect the expertise of the subject matter. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results-Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke but for different reasons. To develop new strategies for prevention and treatment, disease processes and risk factors that lead to pediatric stroke are discussed here to aid the clinician in rapid diagnosis and treatment. The many important differences that affect the pathophysiology and treatment of childhood stroke are discussed in each section. Conclusions-Here we provide updates on perinatal and childhood stroke with a focus on the subtypes, including arterial ischemic, venous thrombotic, and hemorrhagic stroke, and updates in regard to areas of childhood stroke that have not received close attention such as sickle cell disease. Each section is highlighted with considerations for clinical practice, attendant controversies, and knowledge gaps. This statement provides the practicing provider with much-needed updated information in this field. (Stroke. 2019;50:e00-e00.

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“…Neonates and children with cardiac disease comprise one of the highest risk populations for pediatric arterial ischemic stroke (AIS), with a reported annual incidence rate ranging from 132 of 100,000 children to one of 100 children 1,2 compared with two to eight of 100,000 in the general pediatric population. 3,4 This risk persists beyond childhood.…”

Section: Introductionmentioning

confidence: 99%

“…6 In addition, life-saving interventions such as cardiac surgery, cardiac catheterization, and mechanical circulatory support come with the cost of AIS as a potential complication. 2,[7][8][9][10][11] Infection and thrombosis are also complications of cardiac interventions and influence AIS risk. 12 Infection has been shown to play a major role in childhood AIS pathogeneses of all causes, including spontaneous cardioembolic stroke.…”

Section: Introductionmentioning

confidence: 99%

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

Chung

Guilliams

Wilson

et al. 2019

Pediatric Neurology

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Objective: We describe the risk factors for peri-procedural and spontaneous arterial ischemic stroke (AIS) in children with cardiac disease. Methods: We identified children with cardiac causes of AIS enrolled in the International Pediatric Stroke Study registry from January 2003 to July 2014. Isolated patent foramen ovale was excluded. Periprocedural AIS (those occurring during or within 72 hours of cardiac surgery, cardiac catheterization, or mechanical circulatory support) and spontaneous AIS that occurred outside of these time periods were compared. Results: We identified 672 patients with congenital or acquired cardiac disease as the primary risk factor for AIS. Among these, 177 patients (26%) had peri-procedural AIS and 495 patients (74%) had spontaneous AIS. Among non-neonates, spontaneous AIS occurred at older ages (median 4.2 years, interquartile range 0.97 to 12.4) compared with peri-procedural AIS (median 2.4 years, interquartile range 0.35 to 6.1, P < 0.001). About a third of patients in both groups had a systemic illness at the time of AIS. Patients who had spontaneous AIS were more likely to have a preceding thrombotic event (16 % versus 9 %, P ¼ 0.02) and to have a moderate or severe neurological deficit at discharge (67% versus 33%, P ¼ 0.01) compared to those with peri-procedural AIS.

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Stroke in Acquired and Congenital Heart Disease Patients and Its Relationship to Hospital Mortality and Lasting Neurologic Deficits

Cited by 14 publications

References 19 publications

Deterioration of functional abilities in children surviving the Fontan operation

Deterioration of functional abilities in children surviving the Fontan operation

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

Arterial Ischemic Stroke Secondary to Cardiac Disease in Neonates and Children

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