TY - JOUR
T1 - Outcome of Neonates with Vein of Galen Malformation Presenting with Severe Heart Failure: A Case Series.
AU - De Rosa, Gabriella
AU - De Carolis, Maria Pia
AU - Tempera, Alessia
AU - Pedicelli, Alessandro
AU - Rollo, Massimo
AU - Morena, Tony Christian
AU - Luca, Ersilia
AU - De Luca, Daniele
AU - Conti, Giorgio
AU - Piastra, Marco
PY - 2019
Y1 - 2019
N2 - BACKGROUND:
Neonatal presentation of vein of Galen aneurysmal malformations (VGAMs) complicated by cardiac failure and pulmonary hypertension is frequently associated with a poor prognosis. Interventional neuroradiology with embolization can offer a chance for survival, although neurological damage can represent a limitation.
OBJECTIVE:
This article determines if aggressive intensive care and drug management of cardiac failure before urgent embolization can influence morbidity and mortality.
PATIENTS AND METHODS:
Twelve infants (7 boys, 5 girls) were diagnosed with symptomatic vein of Galen malformations in the neonatal period during the period 2000 to 2014. Due to high output cardiac failure, endovascular treatment was attempted as soon as stabilization was achieved.
RESULTS:
Endovascular procedures successfully reverted cardiac failure in 5 patients who survived without significant neurological damage, while in 7 patients the causes of death were refractory cardiac failure, multiorgan failure, and severe brain damage. Bidimensional echocardiography assessment was performed at presentation and after early embolization procedures.
CONCLUSION:
Aggressive intensive care approach to heart failure and pulmonary hypertension leading to early neurointervention results in good survival rates with low morbidity even in cases of high-risk neonatal VGAM. Combined hemodynamic treatment can improve outcome in neonates with cardiac failure secondary to VGAM, although there is the risk of precipitating systemic hypoperfusion and renal failure. A moderate prematurity may not prevent both interventional approach and good outcome.
AB - BACKGROUND:
Neonatal presentation of vein of Galen aneurysmal malformations (VGAMs) complicated by cardiac failure and pulmonary hypertension is frequently associated with a poor prognosis. Interventional neuroradiology with embolization can offer a chance for survival, although neurological damage can represent a limitation.
OBJECTIVE:
This article determines if aggressive intensive care and drug management of cardiac failure before urgent embolization can influence morbidity and mortality.
PATIENTS AND METHODS:
Twelve infants (7 boys, 5 girls) were diagnosed with symptomatic vein of Galen malformations in the neonatal period during the period 2000 to 2014. Due to high output cardiac failure, endovascular treatment was attempted as soon as stabilization was achieved.
RESULTS:
Endovascular procedures successfully reverted cardiac failure in 5 patients who survived without significant neurological damage, while in 7 patients the causes of death were refractory cardiac failure, multiorgan failure, and severe brain damage. Bidimensional echocardiography assessment was performed at presentation and after early embolization procedures.
CONCLUSION:
Aggressive intensive care approach to heart failure and pulmonary hypertension leading to early neurointervention results in good survival rates with low morbidity even in cases of high-risk neonatal VGAM. Combined hemodynamic treatment can improve outcome in neonates with cardiac failure secondary to VGAM, although there is the risk of precipitating systemic hypoperfusion and renal failure. A moderate prematurity may not prevent both interventional approach and good outcome.
KW - Galeno's vein
KW - Galeno's vein
UR - http://hdl.handle.net/10807/152633
U2 - 10.1055/s-0038-1666813
DO - 10.1055/s-0038-1666813
M3 - Article
SN - 0735-1631
VL - 36
SP - 169
EP - 175
JO - American Journal of Perinatology
JF - American Journal of Perinatology
ER -