Download PDF
CC BY 4.0 · J Neuroanaesth Crit Care 2023; 10(03): 209-211
DOI: 10.1055/s-0043-1771221
Case Report

Brain Abscess Drainage in a Case of Tetralogy of Fallot with Pulmonary Atresia with Major Aortopulmonary Collateral Arteries Under Scalp Block

Surya K. Maddala 
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
,
Krishna P. Yadavilli 
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
,
Prasanta K. Das
1   Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
,
Vipin Chandran C.
2   Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. There are a few reports of uncorrected TOF patients surviving into adulthood requiring noncardiac surgery. They are commonly susceptible to developing brain abscesses due to paradoxical embolism and lack of pulmonary phagocytic clearance. A 32-year-old man, a known patient of TOF with pulmonary atresia and major aortopulmonary collateral arteries, presented with left side weakness and seizures. He was drowsy with a Glasgow Coma Scale (GCS) of 13/15, heart rate of 72/min, oxygen saturation of 78% with 6 L/min oxygen via face mask, and blood pressure of 90/60 mm Hg with noradrenaline at 0.5 mcg/kg/min. He had central cyanosis, clubbing, and icterus. The left upper and lower limb power was 2/5, whereas it was 5/5 for the right. Cardiovascular examination revealed a grade 3/6 continuous murmur at the base of the heart. No pulmonary abnormality was noted on auscultation. Echocardiography showed large subaortic ventricular septal defect (VSD) with overriding of the aorta, pulmonary atresia, right-sided aortic arch, and ejection fraction of 62%. Magnetic resonance imaging (MRI) of the brain revealed features suggestive of brain abscess. Brain abscess drainage was performed under scalp block with sedation to avoid major hemodynamic fluctuations. The procedure was uneventful, and the patient's power on the left side improved postprocedure. Scalp block with sedation is a suitable alternative to general anesthesia for drainage of brain abscess in TOF patients.

Keywords

brain abscess - congenital heart disease - pulmonary atresia - scalp block - tetralogy of Fallot


Publication History

Article published online:
23 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Ganigara M, Sagiv E, Buddhe S, Bhat A, Chikkabyrappa SM. Tetralogy of Fallot with pulmonary atresia: anatomy, physiology, imaging, and perioperative management. Semin Cardiothorac Vasc Anesth 2021; 25 (03) 208-217
    CrossrefPubMedGoogle Scholar
  • 2 Thomas SH, Bass P, Pambakian H, Marigold JH. Cyanotic tetralogy of Fallot in a 77 year old man. Postgrad Med J 1987; 63 (739) 361-362
    CrossrefPubMedGoogle Scholar
  • 3 Solanki SL, Jain A, Singh A, Sharma A. Low-dose sequential combined-spinal epidural anesthesia for cesarean section in patient with uncorrected tetrology of Fallot. Saudi J Anaesth 2011; 5 (03) 320-322
    CrossrefPubMedGoogle Scholar
  • 4 Goyal R, Singh S, Bangi A, Singh SK. Case series: dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery. J Anaesthesiol Clin Pharmacol 2013; 29 (04) 543-546
    CrossrefPubMedGoogle Scholar
  • 5 Ahmed I. Tetrology of Fallot and pregnancy. RMJ 2004; 29: 76-79
    PubMedGoogle Scholar
  • 6 Sethi S, Kapil S. Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of Fallot. World J Clin Cases 2014; 2 (12) 934-937
    CrossrefPubMedGoogle Scholar
  • 7 Philip S, Praveen KP. Emergency brain abscess drainage in a case of uncorrected complex congenital heart disease under monitored anesthesia care. Int J Clin Anesthesiol 2019; 2: 3
    PubMedGoogle Scholar