title: Ischemic Stroke after Heart Transplantation.
abstract: Cerebrovascular complications after orthotopic heart transplantation (OHT) are more common in comparison with neurological sequelae subsequent to routine cardiac surgery. Ischemic stroke and transient ischemic attack (TIA) are more common (with an incidence of up to 13%) than intracranial hemorrhage (2.5%). Clinically, ischemic stroke is manifested by the appearance of focal neurologic deficits, although sometimes a stroke may be silent or manifests itself by the appearance of encephalopathy, reflecting a diffuse brain disorder. Ischemic stroke subtypes distribution in perioperative and postoperative period after OHT is very different from classical distribution, with different pathogenic mechanisms. Infact, ischemic stroke may be caused by less common and unusual mechanisms, linked to surgical procedures and to postoperative inflammation, peculiar to this group of patients. However, many strokes (40%) occur without a well-defined etiology (cryptogenic strokes). A silent atrial fibrillation (AF) may play a role in pathogenesis of these strokes and P wave dispersion may represent a predictor of AF. In OHT patients, P wave dispersion correlates with homocysteine plasma levels and hyperhomocysteinemia could play a role in the pathogenesis of these strokes with multiple mechanisms increasing the risk of AF. In conclusion, stroke after heart transplantation represents a complication with considerable impact not only on mortality but also on subsequent poor functional outcome.
authors.affiliation: Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, viale Bracci, Siena, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Acampa
authors.affiliation: Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci, Siena, Italy.
authors.forename: Pietro Enea
authors.initials: PE
authors.lastname: Lazzerini
authors.affiliation: Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, viale Bracci, Siena, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Guideri
authors.affiliation: Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, viale Bracci, Siena, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Tassi
authors.affiliation: Stroke Unit, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General Hospital, viale Bracci, Siena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martini
keywords: Cardioembolism; Heart transplantation; Homocysteine; Inflammation; Ischemic stroke; P wave dispersion