Brain abscess is a serious infection with poor outcome if diagnosed late. Delayed surgical drainage has high morbidity and mortality. The threshold for diagnosis should be low, particularly in children with a predisposing condition like cyanotic congenital heart disease.

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BACKGROUND The HeartMate II is the most frequently used left ventricular assist device (LVAD) in patients with end-stage heart failure. There is a paucity of data regarding its longitudinal cardiac effects, particularly that on diastole. METHODS This retrospective study was an evaluation of echocardiograms pre-operatively, post-operatively and at 3, 6 and 12 month intervals in patients with a HeartMate II. Measurements included left ventricle (LV) dimensions, ejection fraction (EF), right ventricle (RV) size and function, parameters of diastolic function, analysis of mitral regurgitation (MR), tricuspid regurgitation (TR), aortic insufficiency (AI) and aortic valve thickening. RESULTS Forty-seven patients were evaluated. LV size decreased but EF, RV size and RV function were unchanged. Filling improved with a decrease in central venous pressure (CVP). Right ventricular systolic pressure (RVSP) and diastolic parameters including E/A, deceleration time (DT), pulmonary vein inflow, left atrial size and E/e′ all improved. Ventricular relaxation measured by tissue Doppler (e′) was unchanged. Regarding valve function, MR decreased, TR was unchanged and the aortic valve became increasingly thickened with increased AI severity. CONCLUSIONS The HeartMate II unloads the left ventricle shown by decreased LV size, decreased MR and improved filling. Neither systolic function nor diastolic relaxation improves in this cohort of mostly ischemic cardiomyopathy. RV size and function also remained unchanged. The aortic valve shows deterioration with increased thickening and AI likely from valve fusion. These results improve our understanding regarding the effects of the HeartMate II, particularly that on diastole.

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