Arterio-Venous Malformation presenting with Heart Failure in Newborn Period; Vein Of Galen Aneurysmal Malformations

Abstract

The vein of galen aneurysmal malformations VGAM is a rare congenital cerebral arteriovenous deformity. Recently, this anomaly may be diagnosed prenatally by imaging methods. MR-angiography is useful for the post-natal confirmation of VGAM anatomy and the demonstration of the vessels feeding the aneurysm. It occurs most frequently in high-burdened heart failure during the neonatal period. Thus, the greater the severity of heart failure, the lower the response to treatment, and the higher the mortality rate occur, if not treated on time. The successful management and treatment of this condition requires multidisciplinary approach and good follow up. In this study, eleven newborns with VGAM, diagnosed in the prenatal and neonatal period, with severe heart failure and pulmonary hypertension are presented.

Keywords

• galen aneurysmal,heart failure,newborn

Yenidoğan Döneminde Kalp Yetmezliği Bulguları İle Seyreden Arterio-Venöz Malformasyon; Galen Ven Anevrizması

Abstract

Galen ven anevrizması VGAM seyrek görülen serebral arteriyovenöz bir malformasyondur. Günümüzde görüntüleme yöntemleri ile prenatal tanı konabilmekte; doğum sonrası MR anjiyografi ile VGAM anatomisini ve anevrizmal yapıyı besleyen damarlar gösterilebilmektedir. Yenidoğan döneminde en sık yüksek debili kalp yetmezliği ile ortaya çıkar. Bu nedenle kalp yetmezliği ne kadar ağır ise tedaviye yanıt da o kadar azalmakta ve zamanında tedavi edilmediğinde mortalite oranı artmaktadır. Tedavi başarısını artırmak için multidisipliner yaklaşım ve takip önemlidir. Bu yazıda prenatal ve neonatal dönemde ağır kalp yetersizliği ve pulmoner hipertansiyon tanısı almış onbir GVAM’lı hasta sunulmuştur.

Keywords

• Galen ven,kalp yetmezliği,yenidoğan

References

1. Jones BV, Ball WS, Tomsick TA, Millard J, Crone KR. Vein of Galen aneurysmal malformation: diagnosis and treatment of 13 children with extended clinical follow-up. AJNR. American journal of neuroradiology 2002; 23(10): 1717-24.
2. Gailloud P, O’Riordan DP, Burger I, Levrier O, Jallo G, Tamargo RJ et al. Diagnosis and management of vein of galen aneurysmal malformations. Journal of perinatology : official journal of the California Perinatal Asso- ciation 2005; 25(8): 542-51.
3. Paternoster DM, Manganelli F, Moroder W, Nicolini U. Prenatal diagnosis of vein of Galen aneurysmal malformations. Fetal diagnosis and therapy 2003; 18(6): 408-11.
4. Lasjaunias P, Hui F, Zerah M, Garcia-Monaco R, Malherbe V, Rodesch G et al. Cerebral arteriovenous malformations in children. Management of 179 consecutive cases and review of the literature. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 1995; 11(2): 66-79; discussion 79.
5. MG Y. AVM of vein of Galen region, in: Microneurosurgery: AVM of the Brain, Clinical Considerations, General and Special Operative Techniqu- es, Surgical Results, Nonoperated Cases, Cavernous and Venous Angi- omas. Neuroanesthesia 1988; Vol IIIB: pp 323–354.
6. Sasidharan CK, Anoop P, Vijayakumar M, Jayakrishnan MP, Reetha G, Sindhu TG. Spectrum of clinical presentations of vein of galen aneurysm. Indian journal of pediatrics 2004; 71(5): 459-63.
7. Mitchell PJ, Rosenfeld JV, Dargaville P, Loughnan P, Ditchfield MR, Fraw- ley G et al. Endovascular management of vein of Galen aneurysmal mal- formations presenting in the neonatal period. AJNR. American journal of neuroradiology 2001; 22(7): 1403-9.
8. Stephan S, Rodesch G, Elolf E, Wiemann D, Jorch G. Vein of galen aneurysmal malformations: an ultrasonographic incidental finding-a case report. Case reports in pediatrics 2012; 2012: 824284.

9. Ciricillo SF, Edwards MS, Schmidt KG, Hieshima GB, Silverman NH, Hi- gashida RT et al. Interventional neuroradiological management of vein of Galen malformations in the neonate. Neurosurgery 1990; 27(1): 22-7; discussion 27-8.
10. Rodesch G, Hui F, Alvarez H, Tanaka A, Lasjaunias P. Prognosis of an- tenatally diagnosed vein of Galen aneurysmal malformations. Child’s nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 1994; 10(2): 79-83.
11. Tiwary S, Geethanath RM, Abu-Harb M. Vein of Galen malformation pre- senting as persistent pulmonary hypertension of newborn (PPHN). BMJ case reports 2013; 2013.
12. Mathews AZ, Ibhanesebhor S, Richens T, Manjunatha CM. Heart failure in the new born; vein of Galen aneurysmal malformation. BMJ case re- ports 2013; 2013.
13. Chevret L, Durand P, Alvarez H, Lambert V, Caeymax L, Rodesch G et al. Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates presenting with severe heart failure owing to vein of Galen arteriovenous malformation. Intensive care medicine 2002; 28(8): 1126-30.
14. Lasjaunias PL, Chng SM, Sachet M, Alvarez H, Rodesch G, Garcia-Mo- naco R. The management of vein of Galen aneurysmal malformations. Neurosurgery 2006; 59(5 Suppl 3): S184-94; discussion S3-13.
15. Patton DJ, Fouron JC. Cerebral arteriovenous malformation: prenatal and postnatal central blood flow dynamics. Pediatric cardiology 1995; 16(3): 141-4.
16. Beucher G, Fossey C, Belloy F, Richter B, Herlicoviez M, Dreyfus M. [Antenatal diagnosis and management of vein of Galen aneurysm: re- view illustrated by a case report]. Journal de gynecologie, obstetrique et biologie de la reproduction 2005; 34(6): 613-9.
17. Heuchan AM, Bhattacharyha J. Superior vena cava flow and manage- ment of neonates with vein of Galen malformation. Archives of disease in childhood. Fetal and neonatal edition 2012; 97(5): F344-7.
18. Karam O, da Cruz E, Rimensberger PC VGAM induced high-flow con- gestive heart failure responsive to PGE1 infusion., Int J Cardiol. 2009 Feb 20;132(2):e60-2.
19. Ashida Y, Miyahara H, Sawada H, Mitani Y, Maruyama K. Anesthetic management of a neonate with vein of Galen aneurysmal malforma- tions and severe pulmonary hypertension. Paediatr Anaesth. 2005 Jun;15(6):525-8.
20. Chevret L, Durand P, Alvarez H, Lambert V, Caeymax L, Rodesch G, Devictor D, Lasjaunias P. Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates pre- senting with severe heart failure owing to vein of Galen arteriovenous malformation. Intensive Care Med. 2002 Aug;28(8):1126-30.