Gabriella De Rosa1, Maria Pia De Carolis2, Alessia Tempera3, Alessandro Pedicelli4, Massimo Rollo4, Tony Christian Morena5, Ersilia Luca5, Daniele De Luca6, Giorgio Conti5, Marco Piastra5. 1. Department of Paediatric Cardiology, Catholic University "A. Gemelli" Hospital, Rome, Italy. 2. Neonatal Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy. 3. Neonatal Intensive Care Unit, San Camillo-Forlanini Hospital, Rome, Italy. 4. Department of Neuroradiology, Catholic University "A. Gemelli" Hospital, Rome, Italy. 5. Paediatric Intensive Care Unit, Catholic University "A. Gemelli" Hospital, Rome, Italy. 6. Neonatal Intensive Care Unit, Paris-Sud University Hospital, Paris, France.
Abstract
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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: Alfred Pokmeng See; Louise E Wilkins-Haug; Carol B Benson; Wayne Tworetzky; Darren B Orbach Journal: BMJ Open Date: 2022-05-24 Impact factor: 3.006