Brain Abscess Associated with Cyanotic Congenital Heart Disease

Chung, Young Seo; Kim, Dong Ho; Jung, Hee Won; Han, Dae Hee

Abstract

Fourteen cases of brain abscess with cyanotic congenital heart disease operated during 10 years from 1974 to 1983 were reviewed. The abscess associated with cyanotic congenital heart disease constituted 21.8%(14/64) of total brain abscesses during this period. Brain abscess occurred in 1.8%(14/784) of the patients with cyanotic congenital heart disease. Of 14 cases, 12 had a tetralogy of Fallot and others were transposition of the grear vessels and pulmonary atresia. A peak in the age distribution was seen at 5 to 11 years of age and the preponderance of males was present(2:1=M:F). The major symptoms and signs were due to the increased ICP and 21.4%(3/14) of the abscesses was nonfebrile. All of the abscesses were supratentorial and located in temporal, parietal, occipital, frontal area in order of frequency. In one case multiple abscess was present. Sterile cultures were obtained in 57.1%(8/14) of the abscesses. Anaerobic streptococcus, bacteroides, streptococcus, staphylococcus, G(-) rods were cultured. All of the abscesses were treated by surgical management with the overall mortality of 4.3%(2/14). Total excision of the abscess generally resulted in better outcome. Patients were operated upon in the stabilized stage of the disease clinically with the aid of serial CT scan evidence. The introduction of CT scan has facilitated early diagnosis, location, and investigation of the evolution of a abscess to obtain a better postoperative result. However, recent progress in neurosurgery and cardiac surgery has made it possible to extend the normal life of these patients. Therefore we should have to give our attention to the surgical management of the brain abscess associated with cyanotic congenital heart disease seriously.