Late cerebrovascular complications of cardiac transplantation.

The occurrence of stroke after the post-operative period of cardiac transpl antation is a rare event, and the role of the cardiac transplant in these p atients, who often have various vascular risk factors, is unclear. We revie wed the clinical records of 303 consecutive patients with orthotopic cardia c transplantation performed from March 1985 to December 1996 and selected t hose who developed a stroke over the first 2 months postoperatively, in ord er to evaluate the frequency and the mechanisms of late cerebrovascular com plications. Four patients had presented cerebral;infarct and two intracrani al hemorrhage. The overall risk of late cerebrovascular complications was 2 .6p. 100 at 5 years. Ischemic stroke was related to cardiac embolus in one patient, lacunar infarction in another, and was of undetermined etiology in two cases. In addition to vascular risk factors prior to transplantation a nd the development of intracardiac thrombus, immunosuppressive therapy, the surgical procedure and cardiac rejection may play a role in the occurrence of stroke in such patients.