title: Middle Cerebral Artery Stroke in a Neonate With a Congenital Hypercoagulable Condition Following Repair of an H-type Tracheoesophageal Fistula.
abstract: We report a case of middle cerebral artery stroke with heterozygosity for 2 separate hypercoagulable conditions following repair of an H-type tracheoesophageal fistula (TEF) in an infant. Neonatal stroke is rare, occurring in 1 in 4000 births annually in the United States. Stroke after pediatric surgery occurs in approximately 0.05% of patients. Etiologies of stroke in neonates include cardiac, hematologic, vascular, traumatic, metabolic, pharmacologic, infectious, and hypoxemic insults. Thrombophilia has been described in 42% to 78% of neonates with neonatal stroke. Stroke after repair of an H-type TEF has not been reported as a postoperative complication. Manipulation of the carotid artery during this operation is presumed to have contributed to a thromboembolic event in this infant with a hypercoagulable state. Whereas preoperative workup may not be indicated due to the low prevalence of neonatal stroke, workup for a congenital hypercoaguable condition may be considered in infants with stroke as a postoperative complication. This report provides a concise review of the etiology and treatment of stroke and hypercoagulable states in neonates as well as presents the case of a previously undescribed complication of repair of an H-type TEF.
authors.affiliation: Departments of *General Surgery ‡Surgery, Division of Pediatric Surgery †School of Medicine, University of New Mexico, Albuquerque, NM.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Garcia
authors.forename: Katharine
authors.initials: K
authors.lastname: Caldwell
authors.forename: Anna
authors.initials: A
authors.lastname: Kellund
authors.forename: Cynthia
authors.initials: C
authors.lastname: Reyes
mesh_terms: D000818:Animals; D002642:Chick Embryo; D005165:Factor V / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology* / Q000628:therapy; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D019851:Thrombophilia / Q000151:congenital*; D014138:Tracheoesophageal Fistula / Q000601:surgery*
chemical_list: C095381:factor V Leiden; D005165:Factor V