An Unusual Cause of Heart Failure in a Newborn: Your Diagnosis?: A Case Report

Arteriovenous malformations (AVMs) are abnormal connections between an artery and a vein whereby the interconnecting capillary network is missed. Vein of Galen is a short midline venous structure formed by the confluence of the two internal cerebral veins and the basal veins of Rosenthal and the aneurismal malformation of this vein is a congenital vascular anomaly that comprises 30% of the pediatric vascular malformations. The pathogenesis of the vein of Galen aneurysmal malformation (VGAM) is unknown. Here, we report a neonate patient with complications related to vein of Galen aneurysmal malformation.
A 9-day-old male neonate referred with icter, poor feeding, tachypnea, and tachycardia and was admitted to the neonatal intensive care unit (NICU) of Vali-e-Asr hospital in Birjand city, Iran, on 5th July 2016. In his chest X-ray (C-X-ray), a cardiomegaly was shown. Suspecting to congenital heart disease, a transthoracic echocardiography was performed. In echocardiography, a patent foramen ovale (PFO) with the right to left shunt, small ventricular septal defect (VSD), and tiny patent ductus arteriosus (PDA) were observed, which are the signs of heart failure. The observed heart defects in echocardiography did not justify heart failure in this patient; therefore, we decided to do brain and liver sonography for rolled/out AVM. In brain sonography, an echo-free zone in midbrain with very high turbulence flow vessel was observed that confirmed A-V malformation.
In the infancy, VGAM is usually presented with high cardiac output failure that can be associated with multiorgan dysfunction. Since the prenatal diagnosis of VGAM and its treatment will be associated with better prognosis, intrauterine detection of this anomaly and its treatment are recommended.