Department of Pediatric Critical Care, Cleveland Clinic, Cleveland, OH, USA
Department of Neonatology, Cleveland Clinic, Cleveland, OH, USA
Department of Cerebrovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
Department of Cardio-thoracic Surgery, Cleveland Clinic, Cleveland, OH, USA
Address for correspondence: Hemant Agarwal, MBBS, FAAP, Department of Pediatric Critical Care, Cleveland Clinic, 9500 Euclid Avenue, M-14, Cleveland, OH 44195, USA. Tel.: +1 216 444 8498; Fax: +1 216 444 3310; E-mail: [email protected].
Abstract: BACKGROUND:The vein of Galen aneurysm (VGAM) is the most common type of arteriovenous malformation in the neonate. These neonates commonly present with high output cardiac failure that may be associated with pulmonary hypertension. The medical management and stabilization of these neonates can be challenging before staged transarterial embolization of the aneurysm is undertaken. CASE:A 2.34 kilogram neonate, antenatally diagnosed to have VGAM, was born at 36 weeks of gestation for fetal distress. The neonate failed to respond to medical management including inotropes, high frequency mechanical ventilation and inhaled nitric oxide. The patient’s high-output heart failure and persistent pulmonary hypertension were stabilized with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) using central cannulation. Further transarterial staged embolization of the VGAM was undertaken on VA-ECMO support. CONCLUSION:There may be a role of VA-ECMO using central cannulation to optimize management of high output cardiac failure and persistent pulmonary hypertension in neonatal VGAM patients who fail medical management to facilitate staged transarterial embolization of the VGAM.