Risk of stroke in patients with right-sided congenital heart disease and interatrial communication

• Published in: Progress in pediatric cardiology Vol. 45; pp. 75 - 77
• Main Authors: Renaud, Claudia, El Rayes, Malak, Ordonez, Maria Victoria, Marelli, Ariane, Therrien, Judith
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-06-2017
• Subjects: Cerebrovascular events; Interatrial communication; Right-sided congenital heart disease; Interatrial communication; Right-sided congenital heart disease; Cerebrovascular events
• ISSN: 1058-9813; 1558-1519
• DOI: 10.1016/j.ppedcard.2016.11.004

The association between patent oval foramen and cryptogenic stroke has been well described. The reported rate of stroke in young adults is between 6 and 11 per 100,000 patient-years and between 50 and 147 per 100,000 patient-years in adults with congenital heart disease. The purpose of this study was to evaluate the rate of stroke in a subset of patients with congenital heart disease: in patients with right-sided congenital heart disease and interatrial communication. This is a retrospective review of the clinical data from the McGill Adult Unit for Congenital Heart Disease and the Jewish General Hospital Congenital Clinic. Included were patients aged between 16 and 55years with a diagnosis of an atrial septal communication and predominantly right-sided congenital heart disease. Cerebrovascular events were recorded and the rate of cerebrovascular events per patient-year was calculated. There were 198 patients identified who met the inclusion criteria. The total follow up was 6140 patient-years. A total of 13 cases of cerebrovascular events prior to the age of 55years were identified (6.5% of the patients); at a mean age of 40years. The calculated rate of stroke was 210 per 100,000 patient-years. Our results show that patients with interatrial communication and right heart disease are at a much greater risk of stroke compared to the general population and represent a particular segment of adult congenital heart disease at an increased risk of stroke. This study is hypothesis generating and should provide the basis for further analyses aimed at determining whether patients with right-sided congenital heart disease with an interatrial communication should undergo prophylactic closure.
•Patients with an interatrial communication and congenital heart disease affecting the right side of the heart had a 0.21% per patient-year risk of stroke.