CEREBROVASCULAR EVENTS IN ADULT PATIENTS WITH CYANOTIC CONGENITAL HEART-DISEASE

Objectives. We sought to determine the frequency of spontaneous cerebr ovascular events in adult patients,vith cyanotic congenital heart dise ase and to evaluate any contributing factors. Background. Cerebrovascu lar events are a serious complication of cyanotic congenital heart dis ease in infants and children but are said to be uncommon in adults. Me thods. Between 1988 and 1995, 162 patients with cyanotic congenital he art disease (mean age 37 Sears, range 19 to 70) were retrospectively e valuated for any well documented cerebrovascular events that occurred at greater than or equal to 18 gears of age, Events related to procedu res, endocarditis or brain abscess were excluded. Results. Twenty-two patients (13.6%) had 29 cerebrovascular events (1/100 patient-years), There mas no significant difference between those with and without a c erebrovascular event in terms of age, smoking history, degree of eryth rocytosis, ejection fraction or use of aspirin or warfarin (Coumadin). Patients who had cerebrovascular event had a significantly increased tendency to develop hypertension, atrial fibrillation, microcytosis (m ean corpuscular volume <82) and history of phlebotomy (p < 0.05). Even when patients with hypertension or atrial fibrillation were excluded, there was an increased risk of cerebrovascular events associated with microcytosis (p < 0.01). Conclusions. Adults with cyanotic congenital heart disease are at risk of having cerebrovascular events. This risk is increased in the presence of hypertension, atrial fibrillation, hi story of phlebotomy and microcytosis, the latter condition having the strongest significance (p < 0.005). This finding leads us to endorse a more conservative approach toward phlebotomy and a more aggressive ap proach toward treating microcytosis in adults with cyanotic congenital heart disease.