Brain Abscess in Children With Tetralogy of Fallot and Its Prevention

Background: Tetralogy of Fallot (TOF) is the most common congenital cyanotic heart disease. Brain abscess is one of the most serious complications of TOF. Brain abscesses in TOF occur due to hematogenous spread of infection facilitated by right-to-left shunting. This bypasses the pulmonary circulation, preventing normal filtration of blood by alveolar phagocytes, and allows direct entry of pathogens into the systemic circulation. Polycyathemia secondary to chronic hypoxia, which causes hyperviscosity, is a contributory factor in the development of Brain abscess. Corrective surgery of tetralogy of Fallot eliminates the chances of developing brain abscess besides improving the symptom of cyanotic heart disease. Elective repair of this cardiac defect is recommended to be done by the age of 3 months to 11 months, however, high cost of this corrective surgery makes it unaffordable to many of the children belonging to low income and lower middle income countries. Uncorrected TOF in older children makes it vulnerable to its serious complications like brain abscess. Method: We conducted an audit of hospital records to look for the presenting complaints of children admitted with TOF in a tertiary care medical college hospital in eastern India. Results: A total of 21 children with TOF were admitted in department of Pediatrics from the month of September 2022 to September 2025.There were 12 (57%) male and 9 (43%) female. Age of these children varied between 1 year to 15 year with median of 8 years. 8 (38%) of these children had brain abscess during admission. Conclusion: Brain abscess is a serious complication of TOF. A significant number (8/21, 38%) of these children had brain abscess at their presentation. This was in contrast to study by Lakhani et. al. who mentioned that 5-18.7 of children with Cyanotic heart disease developed brain abscess. Considering serious nature of this complication in older children with TOF, we should think about possible preventive measures like maintaining hygiene. Role of antibiotics to be used for prophylaxis for brain abscess , should also be explored. Learning point: There is a need of conducting research to find any role of prophylactic antibiotic in prevention of brain abscess in older children with TOF.