Vein of Galen Aneurysmal Malformation: Emergency Embolization for Cardiac Failure
A 2-month-old female baby presented with severe congestive cardiac failure and was diagnosed with vein of Galen aneurysmal malformation. She needed ventilator support for managing the cardiorespiratory failure before being transferred to our center. On admission to our center, she had transient anuria secondary to prerenal acute renal failure with an elevated urea and normal creatinine, normal liver functions, and severe congestive heart failure causing respiratory failure needing ventilatory support. Echocardiography revealed flow reversal in the descending thoracic aorta, pulmonary artery hypertension, atrial septal defect, and shift of interventricular septum to the left. Ultrasound abdomen did not reveal hepatomegaly. She had an isolated convulsion, and the MRI of the brain did not show any evidence of encephalomalacia or ventriculomegaly. The Bicêtre neonatal evaluation score (BNES) was 9 (cardiac, 1; cerebral, 2; respiratory, 1; hepatic, 3; renal, 2). Cardiorespiratory failure was refractory to medical management needing ventilation, and with a BNES of 9, a decision to treat was undertaken.