BRAIN ABSCESS WITH CONGENITAL HEART DESEASE

Intracranial lesions frequently occur in association with congenital malformation of the heart. Intracranial abscess and cerebral thrombosis are the two most serious complications of the brain due to congenital heart disease.

A fatal cerebrovascular accident or cerebral abscess was once looked upon almost as welcome release from the miserable existence of a cardiac cripple." However, recent progress in neurosurgery and cardiac surgery has made it possible to extend the normal life of these patients. The introduction of computerized tomography (CT) has facilitated early detection and accurate characterization of these lesions.

The clinical signs and symptoms of cerebral abscess are presented with special emphasis on the need for early surgical intervention. The occurrence of persistent headache or lethargy in a patient with congenital heart disease should be thoroughly investigated.

The most common sites for brain abscess were the parietal, frontal, and temporal lobes. The remaining of the abscesses were divided between the occipital lobe, the basal ganglia, and the cerebellar hemisphere.

The most common form of congenital heart disease was Fallot's tetralogy, followed by complete transposition of the great vessels. Other cyanotic heart lesions were tricuspid atresia, ventricular septal defect, atrial septal defect, Ebstein's disease, double outlet in the right ventricle, a single ventricle, and persistent truncus arteriosus

The etiology of hematogenous brain abscess in cyanotic heart disease presents several problems. A palliative shunt procedure increases life expectancy of patients with congenital heart disease because it produces recirculation of venous blood through the systemic arterial vessels. The possibility of development of a cerebral abscess will still be present.

In this paper, we present and discuss several problems concerning surgical management of brain abscesses in congenital cyanotic heart disease.

Key words : brain abscess,congenital heart disease