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European Journal of Echocardiography 2008 9(1):105-106; doi:10.1016/j.euje.2007.03.032
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.

Brain abscess caused by paradoxical embolization in Ebstein's anomaly

M.T. Lønnebakken1,2,*, G. Greve1,3, E. Leirgul1 and E. Gerdts1,2

1 Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
2 Institute of Medicine, University of Bergen, Norway
3 Institute of Clinical Medicine, University of Bergen, Norway

Received 29 November 2006; accepted after revision 24 March 2007; online publish-ahead-of-print 30 June 2007.

* Corresponding author. Tel: +47 55 97 22 20; fax: +47 55 97 51 50. E-mail address: mai.tone.lonnebakken{at}helse-bergen.no


  Abstract

A 25-year-old woman presented with Streptococcus milleri brain abscess. Previous cardiac history was unremarkable. In search for a source of embolism echocardiography was performed and revealed a previous undiagnosed Ebstein's anomaly of moderate severity with apical displacement of the septal leaflet of the tricuspid valve and a secundum atrial septal defect (ASD) with left to right shunt. The combination of increased right atrial pressure caused by Ebstein's and an ASD with possibility of transient right to left shunt predispose for paradoxical embolization. The most likely reason for development of a brain abscess in this patient is septic embolization from an infectious focus outside the heart. Ebstein's anomaly can remain undiagnosed until adulthood if the right ventricle, in spite of the smaller size, is haemodynamically well functioning.

Keywords: Brain abscess; Ebstein's anomaly; Atrial septal defect; Paradoxical embolization; Congenital heart disease


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