Anesthetic management of a neonate with vein of Galen aneurysmal malformations and severe pulmonary hypertension

Abstract

Vein of Galen aneurysmal malformations (VGAMs) are rare congenital vascular malformations and excessive arteriovenous shunt causes intractable congestive high-output heart failure in the neonate. We report a case of successful staged transcatheter embolizations for a neonate with congestive heart failure and pulmonary hypertension (PH). Heart failure was dramatically relieved as the staged procedure progressed. Although transcatheter embolizations is essential for the treatment, inhaled nitric oxide (iNO) was helpful as a bridge treatment to reduce right-to-left shunt before the initial emergency embolization. Endovascular embolization is a less invasive therapy than open cranial surgery and allows hemodynamic stability. Perioperative iNO can be used to manage PH in VGAMs.

Radiological and Clinical Features of Vein of Galen Aneurysmal Malformation In Newborn, Endovascular Interventional Treatment Management: 10 Years Experience

“…Nörolojik hasar vakaların %37-50'sinde görülür. Embolizasyon tedavisi sonrası yaşayan hastaların %66'sı nörolojik olarak normal, %11.5'i orta derecede nörolojik sorunlu, %8.5'i geri dönüşümsüz nörolojik hasarlı olmaktadır (22) . Çoklu organ yetersizliği gelişen hastalarda, serebral infarkt daha yüksek oranlarda görülür ve uzun dönemde nörogelişimsel prognoz daha kötüdür (10) .…”

Forme sévère d’un anévrisme de la veine de Galien compliquée d’encéphalomalacie de révélation anténatale

“…La décou-verte anténatale de cette malformation est rare. Les premiers cas de diagnostic anténatal ont été décrits en 1983 [1]. Grâce au progrès de l'échographie obstétricale et au développe-ment des techniques du doppler, le nombre de cas de diagnostic anténatal ne cesse d'augmenter, et la prise en charge est devenue de plus en plus précoce, améliorant ainsi le pronostic.…”

“…Elle représente moins de 1 % des malformations artérioveineuses cérébrales congénitales [1][2][3][4]. Elle se révèle à l'âge néonatal dans 40 à 50 % des cas [2,5], le plus souvent par un tableau d'insuffisance cardiaque.…”

Intracranial Embolization Procedures

“…Pulmonary hypertension can be treated with inhaled nitric oxide. 87 (i) Use noninvasive imaging (ultrasound and MRA) to get an idea of vascular anatomy to minimize the angiographic studies needed for diagnosis and treatment planning. (j) Using a 4F pediatric catheter as a guide catheter, fl ow directed microcatheters can be used for intracranial navigation.…”