Clinical course and medical management of neonates with severe cardiac failure related to vein of Galen malformation

Hemodynamic disturbances associated with endovascular embolization in newborn infants with vein of Galen malformation

“…This preceded the onset of hypertension and was commenced early, before embolization, in order to stabilize the infant by improving peripheral perfusion and controlling cardiac failure by reducing after-load. 8 The follow-up neuro-imaging in these five infants showed no abnormality, apart from pre-existing lesions found on CT or MRI (cases 2 and 9) before the first endovascular procedures ( Table 1).…”

“…8 Briefly, during the 5-year period of the study, multi-system organ failure was managed increasingly with vasodilator agents, rather than with escalating doses of inotropic drugs (Table 1). Intensive inotropic support was associated with myocardial ischemia and worsening lactic acidosis.…”

“…Intensive inotropic support was associated with myocardial ischemia and worsening lactic acidosis. 8 Inhaled nitric oxide and high-frequency ventilation were used in those infants with severe pulmonary hypertension, and prostaglandin E 1 was given to maintain ductal patency in this group of infants. This was to avoid overwhelming right heart failure, which may occur in infants with a high cardiac output and severe pulmonary hypertension.…”

“…[4][5][6][7] It also reduces arterial blood flow to most organs including the myocardium, particularly in diastole, and results in myocardial ischemia. 2,8 Cardiac failure therefore progressively worsens leading to poor peripheral perfusion, lactic acidosis and ultimately multi-system organ failure. 2 In the past decade, advances in endovascular embolization techniques have led to a reduced mortality and morbidity in infants with VGAM, presenting early with cardiac failure.…”

“…The clinical course and outcome of most of our infants with severe cardiac failure related to VGAM managed at our center with urgent embolization have been reported previously. 8 The purpose of this paper is threefold: to describe the hemodynamic changes following repeated embolization procedures during the neonatal period; to examine the relationship between these hemodynamic changes and hypoxic-ischemic cerebral injury in these infants; and to hypothesize regarding the effect of medical and endovascular treatment on the cerebral circulation.…”