Congenital Heart Disease and Stroke

This article will describe in detail the unique mechanism of stroke in congenital heart disease through paradoxical embolism. The emphasis will be on the influence of hemodynamics of the different types of anomalies on the likelihood of stroke, starting with the high-risk patients with cyanotic congenital heart disease, then the moderate-risk patients with repaired or palliated conditions, the relatively small risk of congenital anomalies with mainly left-to-right shunts, and finally, the very unusual but interesting association of patent foramen ovale with stroke in otherwise normal hearts. Conditions that enhance the formation of potential emboli will be discussed shortly. Two conditions with alleged association to stroke, secondary erythrocythemia and mitral valve prolapse, will be reviewed critically, to claim a lack of a clear association. Stroke and aortic coarctation will be discussed. Other cardiac causes of stroke in patients with congenital heart disease that are not unique to this group will not be covered in this article.