Anne Marie Heuchan1, Jo Bhattacharyha. 1. Department of Neonatal Medicine, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK. anemarie.heuchan@nhs.net
Abstract
OBJECTIVE: Vein of Galen malformation (VGAM) in neonates presents a complex management challenge. Measurement of superior vena cava (SVC) blood flow may provide insights into the haemodynamics of VGAM and the effects of therapeutic intervention. METHODS: SVC flow was assessed in 15 neonates with VGAM. SVC flow results, Bicêtre scores (clinical assessment), echocardiographic assessment and clinical outcomes are presented. RESULTS: SVC flows (166-581 ml/kg/min) were significantly elevated at presentation (p<0.001; normal range 55-111 ml/kg/min). Endovascular intervention was undertaken in 12 cases, with nine survivors. SVC flows decreased sequentially with each embolisation, with a median SVC flow at discharge of 124 ml/kg/min (IQR 79-155 ml/kg/min). All cases with SVC flow >400 ml/kg/min (n=5) had an adverse outcome (death or profound neurological damage). Cases with SVC flow <400 ml/kg (n=10) required embolisation before discharge at a median age of 6 days. There were no survivors with Bicêtre scores <8 (n=2) but the predictive value of early Bicêtre score was poor. CONCLUSIONS: SVC flow measurements provide insight into the haemodynamic challenges of VGAM and provide additional useful prognostic information.
OBJECTIVE: Vein of Galen malformation (VGAM) in neonates presents a complex management challenge. Measurement of superior vena cava (SVC) blood flow may provide insights into the haemodynamics of VGAM and the effects of therapeutic intervention. METHODS: SVC flow was assessed in 15 neonates with VGAM. SVC flow results, Bicêtre scores (clinical assessment), echocardiographic assessment and clinical outcomes are presented. RESULTS: SVC flows (166-581 ml/kg/min) were significantly elevated at presentation (p<0.001; normal range 55-111 ml/kg/min). Endovascular intervention was undertaken in 12 cases, with nine survivors. SVC flows decreased sequentially with each embolisation, with a median SVC flow at discharge of 124 ml/kg/min (IQR 79-155 ml/kg/min). All cases with SVC flow >400 ml/kg/min (n=5) had an adverse outcome (death or profound neurological damage). Cases with SVC flow <400 ml/kg (n=10) required embolisation before discharge at a median age of 6 days. There were no survivors with Bicêtre scores <8 (n=2) but the predictive value of early Bicêtre score was poor. CONCLUSIONS: SVC flow measurements provide insight into the haemodynamic challenges of VGAM and provide additional useful prognostic information.
Authors: Cody Savage; Andrew T Hale; Matthew S Parr; Alexander Hedaya; Benjamin W Saccomano; Georges Bouobda Tsemo; Muhammad U Hafeez; Omar Tanweer; Peter Kan; Laurent J Solomon; Dan Meila; Peter B Dirks; Jeffrey P Blount; James M Johnston; Brandon G Rocque; Curtis J Rozzelle; Kartik Bhatia; Prakash Muthusami; Timo Krings; Jesse Jones Journal: Front Pediatr Date: 2022-09-30 Impact factor: 3.569