Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Journal of Perinatology volume 26, pages 273–278 (2006)Cite this article

Abstract

Objective:

To examine hemodynamic changes following endovascular embolization in newborn infants with vein of Galen malformation and severe cardiac failure in the first week of life.

Study design:

Over a recent 5-year period, nine such infants were identified. In seven of these infants, changes in arterial blood pressure were analyzed in relation to the timing of embolization procedures.

Results:

A significant increase in arterial blood pressure was noted after most embolizations. In two infants, this systemic hypertension was severe and treated using intravenous antihypertensive drugs. Both infants subsequently developed complete infarction of both cerebral hemispheres with sparing of the brainstem and cerebellum. Mortality in the nine infants was 33%, and 83% of the survivors were neurologically normal or near normal at follow-up.

Conclusion:

The systemic hypertension observed following endovascular embolizations may provide a protective mechanism to maintain cerebral blood flow after reperfusion injury. Lowering blood pressure in this situation may therefore be detrimental.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Lasjaunias P . Vein of Galen aneurysmal malformation. In: Lasjaunias P, terBrugge K (eds). Vascular Diseases in Neonates, Infants and Children. Springer Verlag: Berlin, Heidelberg, New York, 1997, pp 67–136.

    Chapter  Google Scholar 

  2. De Victor D, Le Pommelet C . Medical treatment of congestive cardiac failure from cerebral arteriovenous fistulas at Bicetre Hospital. Interv Neuroradiol 1996; 2: 49–52.

    Article  CAS  Google Scholar 

  3. Garcia-Monaco R, De Victor D, Mann C, Hannedouche A, Terbrugge K, Lasjaunias P . Congestive cardiac manifestations from cerebrocranial arteriovenous shunts. Endovascular management in 30 children. Child's Nerv Syst 1991; 7: 48–52.

    Article  CAS  Google Scholar 

  4. Patton DJ, Fouron J-C . Cerebral arteriovenous malformation: prenatal and postnatal central blood flow dynamics. Pediatr Cardiol 1995; 16: 141–144.

    Article  CAS  Google Scholar 

  5. Davis A, Menahem S . Retrograde flow in the distal aortic arch and proximal descending aorta – a clue to presence of major cerebral arteriovenous malformation. Cardiol Young 1993; 3: 161–163.

    Google Scholar 

  6. Cumming GR . Circulation in neonates with intracranial arteriovenous fistula and cardiac failure. Am J Cardiol 1980; 45: 1019–1024.

    Article  CAS  Google Scholar 

  7. Grossman RI, Bruce DA, Zimmerman RA, Goldberg HI, Bilaniuk LT et al. Vascular steal associated with vein of Galen aneurysm. Neuroradiology 1984; 26: 381–386.

    Article  CAS  Google Scholar 

  8. Frawley GP, Dargaville PA, Mitchell PJ, Tress BM, Loughnan P . Clinical course and medical management of neonates with severe cardiac failure related to vein of Galen malformation. Arch Dis Child Fetal Neonatal Ed 2002; 87: F144–F149.

    Article  CAS  Google Scholar 

  9. Gailloud P, O’Riordan DP, Burger I, Levrier O, Jallo G, Tamargo RJ et al. Diagnosis and management of vein of Galen aneurysmal malformations. J Perinatol 2005; 25: 542–551.

    Article  Google Scholar 

  10. Mitchell PJ, Rosenfeld JV, Dargaville P, Loughnan P, Ditchfield MR, Frawley G et al. Endovascular management of vein of Galen aneurysmal malformations presenting in the neonatal period. Am J Neuroradiol 2001; 22: 1403–1409.

    CAS  PubMed  Google Scholar 

  11. Chevret L, Durand P, Alvarez H, Lambert V, Caeymax L, Rodesch G et al. Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates presenting with severe heart failure owing to vein of Galen arteriovenous malformation. Intens Care Med 2002; 28: 1126–1130.

    Article  CAS  Google Scholar 

  12. Bohn D . Congenital diaphragmatic hernia. Am J Respir Crit Care Med 2002; 166: 911–915.

    Article  Google Scholar 

  13. Fullerton HJ, Aminoff AR, Ferriero DM, Gupta N, Dowd CF . Neurodevelopmental outcome after endovascular treatment of vein of Galen malformations. Neurology 2003; 61: 1386–1390.

    Article  CAS  Google Scholar 

  14. Lasjaunias P, Alvarez H, Rodesch G, Garcia-Monaco R, terBrugge K, Burrows P et al. Aneurysmal malformations of the vein of Galen. Follow-up of 120 Children treated between 1984–1994. Interventional Neuroradiology 1996; 2: 15–26.

    Article  CAS  Google Scholar 

  15. Rodesch G, Hui F, Alvarez H, Tanaka A, Lasjaunias P . Prognosis of antenatally diagnosed vein of Galen aneurysmal malformations. Child's Nerv Syst 1994; 10: 79–83.

    Article  CAS  Google Scholar 

  16. Friedman DM, Verma R, Madrid M, Wisoff JH, Berenstein A . Recent improvement in outcome using transcatheter embolization techniques for neonatal aneurysmal malformations of the vein of Galen. Pediatrics 1993; 91: 583–586.

    CAS  Google Scholar 

  17. Taylor W, Lasjaunias P . Cerebral arteriovenous shunts in children: some aspects of presentation and treatment. Imaging 1996; 8: 141–157.

    Google Scholar 

  18. Fellman V, Raivio KO . Reperfusion injury as the mechanism of brain damage after perinatal asphyxia. Pediatr Res 1997; 41: 599–606.

    Article  CAS  Google Scholar 

  19. Ayata C, Ropper AH . Ischemic brain oedema. J Clin Neurosci 2002; 9: 113–124.

    Article  Google Scholar 

  20. Boylan GB, Young K, Panerai RB, Rennie JM, Evans DH . Dynamic cerebral autoregulation in sick newborn infants. Pediatr Res 2000; 48: 12–17.

    Article  CAS  Google Scholar 

  21. Rosenbaum JL, Almli CR, Yundt KD, Altman DI, Powers WJ . Higher neonatal cerebral blood flow correlates with worse childhood neurologic outcome. Neurology 1997; 49: 1035–1041.

    Article  CAS  Google Scholar 

  22. Pryds O, Edwards AD . Cerebral blood flow in the newborn infant. Arch Dis Child Fetal Neonatal Ed 1996; 74: F63–F69.

    Article  CAS  Google Scholar 

  23. O’Connell J, Gray CS . Treating hypertension after stroke. BMJ 1994; 308: 1523–1524.

    Article  Google Scholar 

  24. Blood Pressure in Acute Stroke collaboration (BASC). Interventions for deliberately altering blood pressure in acute stroke. Cochrane Database Sys Rev 2001; 2: (CD000039).

  25. Adams Jr HP, Brott TG, Crowell RM, Furlan AJ, Gomez CR, Grotta J et al. AHA Medical/Scientific statement: special report: guidelines for the management of patients with acute ischaemic stroke. Circulation 1994; 90: 1588–1601.

    Article  Google Scholar 

  26. Castillo J, Leira R, Garcia MM, Serena J, Blanco M, Davalos A . Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor outcome. Stroke 2004; 35: 520–526.

    Article  Google Scholar 

  27. Brott T, Bogousslavsky J . Treatment of acute ischemic stroke. N Engl J Med 2000; 343: 710–722.

    Article  CAS  Google Scholar 

  28. Oliveira-Filho J, Silva SC, Trabuco CC, Pedreira BB, Sousa EU, Bacellar A . Detrimental effect of blood pressure reduction in the first 24 h of acute stroke onset. Neurology 2003; 61: 1047–1051.

    Article  CAS  Google Scholar 

  29. Rordorf G, Cramer SC, Efird JT, Schwamm LH, Buonanno F, Koroshetz WJ . Pharmacological elevation of blood pressure in acute stroke. Clinical effects and safety. Stroke 1997; 28: 2133–2138.

    Article  CAS  Google Scholar 

  30. McKinstry RC, Miller JH, Snyder AZ, Mathur A, Schefft GL, Almli CR et al. A prospective, longitudinal diffusion tensor imaging study of brain injury in newborns. Neurology 2002; 59: 824–833.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are grateful to the Newborn Emergency Transport Service, Victoria, Australia. They provided the technological support to move these critically ill infants between the two hospitals for endovascular procedures. We also thank Professor Adrian Walker at the Ritchie Centre for Baby Health Research, Monash University, Melbourne, Australia, for his assistance with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Neonatology, The Royal Children's Hospital, Melbourne, Australia

    F Y Wong, P A Dargaville & P M Loughnan

  2. Department of Radiology, The University of Melbourne, The Royal Melbourne Hospital, Melbourne, Australia

    P J Mitchell & B M Tress

Authors
  1. F Y Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P J Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B M Tress
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P A Dargaville
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P M Loughnan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F Y Wong.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wong, F., Mitchell, P., Tress, B. et al. Hemodynamic disturbances associated with endovascular embolization in newborn infants with vein of Galen malformation. J Perinatol 26, 273–278 (2006). https://doi.org/10.1038/sj.jp.7211479

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211479

Keywords

This article is cited by

Search

Advanced search

Quick links