P28: Vein of Galen Malformation In Newborn With Heart Failure

Introduction : Extracardiac arteriovenous malformations are an uncommon cause of severe cardiac failure in infancy. Aneurysm of the vein of Galen may lead to diagnostic confusion because the presenting signs point to cardiac cause as a cause of cardiac failure. A neonate with such a condition is reported here. Case description : A newborn boy with birth weight of 3.4 kg was limp and cyanosed at birth. Despite maximum positive pressure ventilation the oxygen saturation ranged from 75 to 78%. Physical examination revealed swelling of the neck bilaterally, which is soft and expansile. Loud bruit was detected on the head and neck, and a loud systolic murmur all over the precordium. There were gross cardiomegaly and hepatomegaly. The initial blood gas showed severe respiratory and metabolic acidosis and poor oxygenation. Echocardiography demonstrated normal cardiac anatomy, and a patent ductus arteriosus. The brachiocephalic artery and left common carotid artery were dilated. Cranial ultrasound confirmed the presence of aneurysm of vein of Galen. Despite optimal support the infant succumbed to the condition before embolisation could be performed. Conclusion : Clinical diagnosis of cerebral arteriovenous fistula in newborn maybe difficult. In an infant with unexplained heart failure extracardiac arteriovenous malformation must be considered.