Risk factors for brain abscess in patients with congenital heart disease

Abstract

Brain abscess remains a serious complication of congenital heart disease. To determine risk factors for brain abscess in patients with this condition, data in 26 cases of cyanotic congenital heart disease and brain abscess studied between 1960 and 1973 were reviewed and compared with data in a control group with cyanotic congenital heart disease without brain abscess. Brain abscess occurred in 2 percent of the population with cyanotic congenital heart disease. Tetralogy of Fallot and dextrotransposition of the great arteries accounted for 81 percent (21 of 26) of the cases. The mean arterial oxygen saturation in the patients with brain abscess was 75 percent compared with 86 percent in the control patients ( P < 0.01). Among the patients with brain abscess, the survivors (16 of 26) had a mean oxygen saturation of 81 percent whereas those who died had a mean oxygen saturation of 64 percent ( P = 0.01). The overall mortality rate in the patients with brain abscess was 38 percent (10 of 26). Among survivors, 54 percent (8 of 15) had complete recovery and 46 percent (7 of 15) had residual neurologic impairment. We conclude that the morbidity and mortality of brain abscess are inversely related to oxygen saturation levels. Since brain abscess is exceedingly rare in patients under age 2 years, corrective surgery before this age would probably reduce the incidence of brain abscess in patients with congenital heart disease.