Arteriovenous malformation of galen vein: a rare cause of heart failure in the neonatal period - case report
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Abstract
Introduction: Vein of Galen arteriovenous malformation (VGAM) represents approximately 1% of intracranial vascular malformations and it is classified according to the location of the fistula: choroidal and mural. The choroidal subtype is mostly observed in newborns and commonly progresses to severe cardiac failure (CF), being associated with high rates of neonatal mortality. Objective: To present the case of a newborn admitted to the intensive care unit with a diffi
cult clinical picture of CF secondary to VGAM. Case report: Newborn with a prenatal diagnosis of VGAM by obstetric ultrasound, born at 40 weeks and 4 days by cesarean section, Apgar 6 and 8, underwent neonatal resuscitation with good response. After 48 hours of life, the patient evolved to high output CF. Due to the worsening of the clinical conditions, it was necessary to resort to mechanical ventilation and therapy with diuretics and inotropic agents. On the 7th day of life, the patient evolved to supraventricular tachycardia that was non-responsive to adenosine, requiring electrical cardioversion. He died on the 23rd day of life. Discussion: The clinical presentation of
VGAM depends on the age the disease manifests. The patient in this study had a choroid-type VGAM, causing early cardiac dysfunction in the newborn. Therefore, the management of his CF is a challenge that includes the administration of inotropic drugs, vasodilators, and diuretics. The unfavorable combination of VGAM with severe CF, as sociated with the early presentation of symptoms explains the rapid deterioration of the clinical condition of this patient.
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