Extra corporeal membrane oxygenation support for neonatal vein of Galen aneurysmal malformation: Case report

BACKGROUND: The vein of Galen aneurysm (VGAM) is the most common type of arteriovenous malformation in the neonate. These neonates commonly present with high output cardiac failure that may be associated with pulmonary hypertension. The medical management and stabilization of these neonates can be challenging before staged transarterial embolization of the aneurysm is undertaken. CASE: A 2.34 kilogram neonate, antenatally diagnosed to have VGAM, was born at 36 weeks of gestation for fetal distress. The neonate failed to respond to medical management including inotropes, high frequency mechanical ventilation and inhaled nitric oxide. The patient’s high-output heart failure and persistent pulmonary hypertension were stabilized with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) using central cannulation. Further transarterial staged embolization of the VGAM was undertaken on VA-ECMO support. CONCLUSION: There may be a role of VA-ECMO using central cannulation to optimize management of high output cardiac failure and persistent pulmonary hypertension in neonatal VGAM patients who fail medical management to facilitate staged transarterial embolization of the VGAM.

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Vein of Galen aneurysmal malformations associated with high output cardiac failure: Report of three autopsy cases

Journal of Pediatric Neurology ◽

10.3233/jpn-2011-0475 ◽

2015 ◽

Vol 09 (02) ◽

pp. 227-232

Author(s):

Reenu Malhotra ◽

Luisa Florez ◽

Dollett White ◽

Sozos Papasozomenos ◽

Michael Covinsky ◽

...

Keyword(s):

Cardiac Failure ◽

Vein Of Galen ◽

High Output

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High-output cardiac failure secondary to high-output arteriovenous fistula: investigations, management and definitive treatment

BMJ Case Reports ◽

10.1136/bcr-2019-233669 ◽

2020 ◽

Vol 13 (2) ◽

pp. e233669 ◽

Cited By ~ 1

Author(s):

James Leon Hartley ◽

Asheesh Sharma ◽

Lamis Taha ◽

Thomas Hestletine

Keyword(s):

Pulmonary Hypertension ◽

Arteriovenous Fistula ◽

Cardiac Failure ◽

Rare Complication ◽

Definitive Treatment ◽

Progressive Dyspnoea ◽

Dialysis Fistula ◽

End Stage ◽

Haemodialysis Treatment ◽

High Output

A 32 year-old woman was admitted to our institution with progressive dyspnoea. Her medical history was notable for end-stage renal failure secondary to chronic pyelonephritis, and she had undergone a cadaveric renal transplant in 2010. This had been preceded by haemodialysis treatment via a radiocephalic arteriovenous fistula. Her diagnostic evaluation was remarkable for pulmonary hypertension. A subsequent doppler ultrasound of her arteriovenous fistula revealed a blood flow of 3 L/min. This is consistent with a high output fistula. Echocardiography demonstrated an improvement in pulmonary artery pressure with occlusion of the fistula. After multidisciplinary discussion, a decision was made to surgically tie off her fistula. The patient experienced immediate improvement in her shortness of breath along with resolution of pulmonary hypertension on echocardiography. This case highlights the rare complication of high output cardiac failure from a dialysis fistula and its successful surgical management.

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Prenatal Diagnosis of Vein of Galen Aneurysmal Malformation Allows Early Transumbilical Endovascular Treatment

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1710311 ◽

2020 ◽

Vol 39 (03) ◽

pp. 213-216 ◽

Cited By ~ 1

Author(s):

Zeferino Demartini ◽

Gelson Luis Koppe ◽

Luana A.M. Gatto ◽

Ana Lucia Sarquis ◽

Alexandre N. Francisco ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Prenatal Diagnosis ◽

Endovascular Treatment ◽

Endovascular Therapy ◽

Cardiac Failure ◽

Early Treatment ◽

Vein Of Galen ◽

Umbilical Vessels ◽

Delivery Planning ◽

Perinatal Management

AbstractNeonates with vein of Galen aneurysmal malformation (VGAM) presenting with severe cardiac failure and pulmonary hypertension represent a challenge for endovascular therapy. When early treatment is required, the small femoral arteries in this population are usually difficult to cannulate. Alternatively, the umbilical vessels offer a natural pathway to reach the lesion. Therefore, prenatal diagnosis of VGAM allows for delivery planning, perinatal management, and embolization through umbilical approach, thus leading to better outcomes.

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High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

Case Reports in Vascular Medicine ◽

10.1155/2016/8564081 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Uygar Teomete ◽

Rubee Anne Gugol ◽

Holly Neville ◽

Ozgur Dandin ◽

Ming-Lon Young

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Pulmonary Hypertension ◽

High Risk ◽

Cardiac Failure ◽

Pulmonary Artery Hypertension ◽

Hemodynamic Effect ◽

Av Fistula ◽

History Of ◽

High Output

Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created.Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved.Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics.

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Vein of Galen Aneurysmal Malformation Associated with High Output Cardiac Failure in Three Neonates

The FASEB Journal ◽

10.1096/fasebj.21.5.a76-b ◽

2007 ◽

Vol 21 (5) ◽

Author(s):

Reenu Kapur Malhotra ◽

Luisa Florez ◽

Dollett White ◽

Sozos Papasozomenos ◽

Michael Covinsky ◽

...

Keyword(s):

Cardiac Failure ◽

Vein Of Galen ◽

High Output

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An Elderly Case of Pulmonary Hypertension Presenting High-output Cardiac Failure

Nihon Naika Gakkai Zasshi ◽

10.2169/naika.107.304 ◽

2018 ◽

Vol 107 (2) ◽

pp. 304-314

Author(s):

Shinji Sunaga ◽

Ryo Matsuoka ◽

Nobuhiko Ito ◽

Toru Satoh ◽

Masaru Hatano ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Cardiac Failure ◽

High Output

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1513: CENTRAL CANNULATION OF VA ECMO FOR SEVERE PULMONARY HYPERTENSION AND CARDIOGENIC SHOCK

Critical Care Medicine ◽

10.1097/01.ccm.0000812376.03910.6c ◽

2021 ◽

Vol 50 (1) ◽

pp. 760-760

Author(s):

Shruti Shankar ◽

Ricardo Restrepo ◽

Debabrata Bandyopadhyay ◽

Nirmal Sharma ◽

Kapilkumar Patel

Keyword(s):

Pulmonary Hypertension ◽

Cardiogenic Shock ◽

Severe Pulmonary Hypertension ◽

Va Ecmo ◽

Central Cannulation

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A Case of Neonate with Vein of Galen Malformation Refractory to Weaning Attempts from Mechanical Ventilation Managed Successfully with Noninvasive Ventilation

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0038-1670361 ◽

2018 ◽

Vol 05 (03) ◽

pp. 198-200

Author(s):

Ashutosh Kumar ◽

Neeraja Ajayan ◽

Manikandan Sethuraman ◽

Ajay Prasad Hrishi

Keyword(s):

Mechanical Ventilation ◽

Noninvasive Ventilation ◽

Cardiac Failure ◽

Fluid Overload ◽

Extubation Failure ◽

Vein Of Galen ◽

Vein Of Galen Malformation ◽

Successful Weaning ◽

High Output

AbstractWeaning of patients with vein of Galen malformations (VOGM) from mechanical ventilation can be challenging in the postprocedure period due to underlying high-output cardiac failure and the fluid overload caused by the neurointervention procedure. We present the case of a neonate with VOGM who was refractory to multiple weaning attempts from mechanical ventilation and was successfully managed with noninvasive ventilation (NIV). NIV can be safely used as a method of weaning, post mechanical ventilation in this subset of patients. The use of NIV will facilitate successful weaning and reduce the incidence of extubation failure in neonates with VOGM in cardiac failure.

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