Cerebrovascular accidents in Ebstein's anomaly.
Adolescent
Adult
Aged
Aged, 80 and over
Cardiac Surgical Procedures
/ adverse effects
Child
Child, Preschool
Ebstein Anomaly
/ diagnostic imaging
Embolism, Paradoxical
/ diagnostic imaging
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Middle Aged
Minnesota
/ epidemiology
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Stroke
/ diagnostic imaging
Time Factors
Young Adult
Ebstein’s anomaly
cerebrovascular accident
stroke
Journal
Congenital heart disease
ISSN: 1747-0803
Titre abrégé: Congenit Heart Dis
Pays: United States
ID NLM: 101256510
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
received:
04
02
2019
revised:
23
05
2019
accepted:
29
08
2019
pubmed:
24
9
2019
medline:
1
7
2020
entrez:
24
9
2019
Statut:
ppublish
Résumé
Mechanisms and risk factors for cerebrovascular accidents (CVAs) in Ebstein's anomaly (EA) are not well understood; hence, we aimed to clarify these in a large cohort of EA patients. Patients with a confirmed diagnosis of EA were retrospectively reviewed. Baseline characteristics were compared between patients with and without a prior history of CVA using logistic regression modeling. Cox regression analysis was used to identify predictors of CVA following initial evaluation. CVA incidence from birth and following tricuspid valve surgery were estimated using the Kaplan-Meier method. Nine hundred sixty-eight patients (median age 21.1 years, 41.5% male) were included, in which, 87 patients (9.0%) had a history of CVA (54 strokes, 33 transient ischemic attacks; 5 associated with brain abscesses) prior to their initial evaluation. The odds of atrial septal defect/patent foramen ovale (odds ratio [OR] 4.91; 95% CI 2.60-21.22; p = .0002) and migraines/headaches (OR 2.38; 95% CI 1.40-4.04; p = .0013) but not atrial arrhythmias (OR 0.75; 95% CI 0.44-1.30; p = .31) were significantly higher among patients with prior CVA following multivariable adjustment. Seventeen patients experienced CVA following initial evaluation; no examined variables including atrial arrhythmias (HR 2.38; 0.91-6.19; p = .076) were predictive of CVA risk. The 10-year, 50-year, and 70-year incidences of CVA were 1.4%, 15.9%, and 23.5%, respectively, with paradoxical embolism heavily implicated. Patients with EA are at substantive risk for CVA. Histories of migraines/headaches and interatrial shunts should prompt concern for paradoxical embolic CVAs. This has significant implications for all patients with atrial-level shunting.
Types de publication
Journal Article
Langues
eng
Pagination
1157-1165Informations de copyright
© 2019 Wiley Periodicals, Inc.
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