Usha Rajaram
Al-Jahra Hospital, Kuwait
Title: Cardiac failure in a neonate- Pulsating Brain. Successful endovascular embolization of Vein of Galen malformation
Biography
Biography: Usha Rajaram
Abstract
An inborn neonate ,female, the third child of consanguineous Kuwaiti parents ,37 weeks gestation ,uneventful pregnancy for the mother with no high risk factors, was admitted into the neonatal intensive care at 24 hours of age ,due to respiratory distress with tachyapnoea, respiratory rate of 60 /minute, cardiac rate of 110/minute, normal mean systemic blood pressure with a slightly widened pulse pressure of 25 mm of Hg ,normal oxygen saturation ,minimal hepatomegaly. There were no dysmorphic features, acyanotic in room air, normal cardiac examination with only a persistent gallop rhythm and a mild cardiomegaly on x-ray chest .The Hct was normal. The child was evaluated by cardiologists on three days and diagnosed as having high output failure without any structural congenital cardiac defect or myocardial dysfunction clinically and by echocardiogram. Aggressive management for cardiac failure was instituted Endocrine work up showed no thyrotoxicosis .On the 3rd day of life, cranial ultrasound performed routinely by neonatologist showed a Vein of Galen malformation, confirmed by angiogram. The child at one month of age received endovascular embolization of the Vein of Galen malformation at the institute in Paris .The cardiac failure was controlled. At 6 years of age, the child has normal growth and development, both neurological and school performance. There is no hydrocephalus, only one episode of febrile seizure at 8 months of age with normal electroencephalogram repeated angiographic evaluation showed obliteration of aneurysmal malformation. This clinical report illustrates early recognition of VEIN of Galen malformation, as a cause of neonatal cardiac failure by the neonatal team and early endovascular embolization management with trans-arterial deposition of n-butyl cyanoacrylate into fistula sites shows improved outcome without complications in childhood. Treatment of refractory heart failure in neonatal VGAM with modern prenatal and pediatric neuro-endovascular care results in significantly improved outcomes with presumed cure and normal neurological development in most