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Ungureanu A, Nagy RD, Constantin C, Gheonea IA, Iliescu DG. Prenatal Diagnosis and Prognosis of Abdominal Arteriovenous Fistulae: A Comprehensive Case Series and Systematic Review. Diagnostics (Basel) 2024; 14:826. [PMID: 38667471 PMCID: PMC11048791 DOI: 10.3390/diagnostics14080826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
This study had two main objectives. Firstly, we conducted a thorough literature review on the prenatal diagnosis of abdominal congenital arteriovenous fistulas (CAVFs) involving the abdominal aorta and hepatic arteries. Secondly, we aimed to provide detailed descriptions of eight additional cases diagnosed at our medical center and assess the outcome of this anomaly for informed counseling. We conducted a systematic search of online databases using specific keywords like "outcome", "ultrasound", "intrahepatic fistulae", and "fetal venous anomalies", focusing on studies published between 1998 and 2023. We selected 10 relevant articles and analyzed 13 cases. Additionally, we conducted a five-year prospective study in two referral centers, identifying eight CAVF cases with an incidence rate of 0.16%. Among the 21 cases evaluated, 11 resulted in live births, all of which received treatment. However, four cases (36.3%) had poor postnatal outcomes and neonatal demise due to heart failure. Prenatal signs of poor fetal hemodynamics, including cardiomegaly or hydrops, were observed in 52.3% of cases, regardless of outcome. Our findings highlight the rarity of this vascular malformation and emphasize the importance of effective treatment to avoid unfavorable outcomes. The long-term effectiveness of prenatal treatment or postnatal embolization remains uncertain, with liver transplantation being considered the most reliable treatment option.
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Affiliation(s)
- Anda Ungureanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.U.); (D.G.I.)
- Department of Cardiology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
| | - Rodica Daniela Nagy
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
| | - Cristian Constantin
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.C.); (I.A.G.)
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.C.); (I.A.G.)
| | - Dominic Gabriel Iliescu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.U.); (D.G.I.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital Craiova, 200642 Craiova, Romania
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Pfeifer J, Wohlgemuth WA, Abdul-Khaliq H. Liquid Embolization of Peripheral Arteriovenous Malformations with Ethylene-Vinyl Alcohol Copolymer in Neonates and Infants. Cardiovasc Ther 2022; 2022:1022729. [PMID: 35936795 PMCID: PMC9313932 DOI: 10.1155/2022/1022729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
In the postnatal period, extensive peripheral arteriovenous malformations (AVM) are associated with high morbidity, especially when localized in the liver. Their urgent treatment is always a challenging problem in neonates and infants. We analyzed four consecutive children aged three days to three years who underwent eight liquid embolization procedures with ethylene-vinyl alcohol copolymer. The AVM were situated on the thoracic wall, in the liver, and on the lower leg. In three cases, the malformations showed total regression. The tibial AVM degenerated widely. If impaired beforehand, cardiac or hepatic function normalized after the interventions. There were no embolization-associated complications such as nontarget embolization or tissue ischemia. We conclude that application of ethylene-vinyl alcohol copolymer seems to be a safe therapeutic option and can be used in neonates and infants with peripheral AVM in consideration of the agent's characteristics. Nevertheless, there are still hardly any data concerning young children.
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Affiliation(s)
- Jochen Pfeifer
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg 66421, Germany
| | - Walter A. Wohlgemuth
- Department for Radiology, Martin-Luther-University Halle-Wittenberg, Halle 06120, Germany
| | - Hashim Abdul-Khaliq
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg 66421, Germany
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Zhang XT, Ren WD, Song G, Xiao YJ, Sun FF, Wang N. Infantile hepatic hemangiomas associated with high-output cardiac failure and pulmonary hypertension. BMC Cardiovasc Disord 2019; 19:216. [PMID: 31601179 PMCID: PMC6788120 DOI: 10.1186/s12872-019-1200-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infantile hepatic hemangioma (IHH) is a rare endothelial cell neoplasm, which may be concurrent with severe complications and result in poor outcomes. Moreover, the coexistence of IHH and congenial heart disease is even rarer. CASE PRESENTATION We present a 10-day-old male born with IHH associated with patent ductus arteriosus (PDA), atrial septal defect (ASD) and pulmonary hypertension. Moreover, we reviewed a series of studies of IHH-associated high-output cardiac failure between 1974 and 2018, and summarized the treatment outcomes. CONCLUSIONS Infantile hepatic hemangioma (IHH) has been known to induce high-output heart failure. There is no literature to summarize the severity of its impact on heart, which can lead to a high mortality rate. When IHH is detected by ultrasound, the heart should be evaluated to facilitate treatment. The outcomes of IHH associated with heart failure are good.
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Affiliation(s)
- Xin-Tong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Wei-Dong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China.
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Yang-Jie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Fei-Fei Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
| | - Nan Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, sanhao street 36#, Shenyang, 110004, CN, China
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4
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Markiewicz-Kijewska M, Kasprzyk W, Broniszczak D, Bacewicz L, Ostoja-Chyzynska A, Ismail H, Kosciesza A, Dembowska-Baginska B, Teisseyre J, Kluge P, Brzezinska-Rajszys G, Jankowska I, Kalicinski P. Hemodynamic failure as an indication to urgent liver transplantation in infants with giant hepatic hemangiomas or vascular malformations--report of four cases. Pediatr Transplant 2009; 13:906-12. [PMID: 18992048 DOI: 10.1111/j.1399-3046.2008.01050.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to present acute hemodynamic failure as a rare indication for liver transplantation in neonates and infants with liver hemangiomatosis. We report four patients aged one to six months with giant liver hemangiomas, with huge arterio-venous shunting within these malformations. In three, many skin hemangiomas were found. All children developed right ventricular failure. In two, a trial of pharmacological reduction was attempted with corticosteroids and cyclophosphamide. In one patient, the arterio-venous fistulas were embolized without any improvement in hemodynamic status. Two children underwent rescue hepatic artery surgical ligation, which did not prevent heart and then multiorgan failure including liver failure. After unsuccessful conventional therapy, all infants were considered for urgent liver transplantation; in three cases, it was performed with a living-related donor, and in one case with a deceased donor. All patients are alive and well with the follow-up between nine and 37 months after transplantation. Liver transplantation should be considered as a rescue treatment in children with hepatic vascular malformations leading to hemodynamic insufficiency when conventional therapy is unsuccessful and multiorgan failure develops.
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Tannuri ACA, Tannuri U, Lima FR, Ricardi LRS, Leal AJG, da Silva MM. Congenital intrahepatic arterioportal fistula presenting as severe undernutrition and chronic watery diarrhea in a 2-year-old girl. J Pediatr Surg 2009; 44:e19-22. [PMID: 19853734 DOI: 10.1016/j.jpedsurg.2009.07.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 07/10/2009] [Accepted: 07/10/2009] [Indexed: 12/26/2022]
Abstract
Intrahepatic arterioportal fistula (IAPF) is a rare cause of portal hypertension in young children. We report the case of a 2-year-old girl with severe undernutrition, chronic watery diarrhea, and gastrointestinal bleeding because of a congenital intrahepatic arterioportal fistula. Radiographic embolization and surgical ligation of the left hepatic artery were attempted, with no resolution of the symptoms. So, a left lobectomy was performed, with excellent results and prompt disappearance of the diarrhea. Hepatectomy should be considered as a definitive and reliable therapy for congenital IAPF.
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Affiliation(s)
- Ana Cristina Aoun Tannuri
- Pediatric Surgery Division, Pediatric Liver Transplantation Unit and Laboratory of Research in Pediatric Surgery (LIM 30), University of Sao Paulo Medical School, Sao Paulo, Brazil.
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Sutcliffe R, Mieli-Vergani G, Dhawan A, Corbally M, Karani J, Heaton N. A novel treatment of congenital hepatoportal arteriovenous fistula. J Pediatr Surg 2008; 43:571-3. [PMID: 18358306 DOI: 10.1016/j.jpedsurg.2005.07.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Congenital hepatoportal arteriovenous fistula is a rare cause of portal hypertension in young children. Unlike the acquired form, which is usually isolated and can be cured by hepatic artery (HA) embolization, recurrence of portal hypertension often occurs with congenital hepatoportal arteriovenous fistula after embolization and/or HA ligation because of early, rapid collateralization and the presence of multiple arterioportal fistula. Although long-term outcome after embolization is not known, liver transplantation has been proposed as the only option for this condition. However, portal vein and hepatic arterial anastomoses are made difficult because of the presence of portal vein arterialization and previous HA ligation, with a significantly increased risk of vascular complications. We report a case where resolution of portal hypertension has been achieved by an end-to-side portocaval shunt, to preserve the portal vein and HA for future liver transplantation, should it be required.
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Affiliation(s)
- R Sutcliffe
- Liver Transplant Surgical Service, King's College Hospital, London SE5 9RS, UK
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Lima M, Lalla M, Aquino A, Dòmini M, Tursini S, Ruggeri G, Pelusi G, Pigna A, Tani G, Pilu GL, Prandstraller D, Salfi N. Congenital symptomatic intrahepatic arteriovenous fistulas in newborns: management of 2 cases with prenatal diagnosis. J Pediatr Surg 2005; 40:e1-5. [PMID: 16226966 DOI: 10.1016/j.jpedsurg.2005.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Fetal and neonatal hepatic arteriovenous fistulas are rare and associated with a high mortality rate; they can be prenatally detected by ultrasonography. Management of these malformations can be a challenge for pediatric surgeons. METHODS Two patients with a prenatal diagnosis of intrahepatic arteriovenous shunts were treated at our institution in the last 2 years. A hepatic complex arteriovenous malformation fed respectively by prominent branches of the hepatic artery and of the celiac trunk rising from dilated suprarenal aortae and draining into suprahepatic veins was detected. In the first case, an embolization was performed; in the second, the surgical resection of the vascular malformation was the treatment of choice. RESULTS The first patient died after embolization and before surgery for hemodynamic complications. The second patient, at a follow-up of 16 months, is alive and doing well. CONCLUSION Hepatic resection is the treatment of choice for localized intrahepatic arteriovenous malformation. Theoretically, embolization could be curative or reduce the size of a malformation, making consequent hepatic resection feasible. Results do not support this theory because of the high rate of complications recorded that brought in every case, ours included, to the death of the child.
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Affiliation(s)
- Mario Lima
- Department of Pediatric Surgery, University of Bologna, 40138 Bologna, Italy.
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Jee SH, Grow JL, Faix RG. Intraparenchymal brain hemorrhage and remote soft tissue arteriovenous malformation in a newborn infant. J Perinatol 2002; 22:664-6. [PMID: 12478451 DOI: 10.1038/sj.jp.7210773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital arteriovenous malformations (AVMs) often present with congestive heart failure. Such pathologic vascular structures typically occur in cranial, hepatic, or pulmonary locations and are usually associated with overlying external visible, tactile, or audible abnormalities. These vascular anomalies may also be associated with such complications as thromboembolic events, coagulopathy, and localized hemorrhage. We present a newborn infant with an occult but hemodynamically significant parascapular AVM who presented with an intraparenchymal brain hemorrhage, which we suspect to be a remote complication of the AVM.
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Affiliation(s)
- Sandra H Jee
- Department of Pediatrics and Communicable Diseases, Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Agarwala S, Dutta H, Bhatnagar V, Gulathi M, Paul S, Mitra D. Congenital hepatoportal arteriovenous fistula: report of a case. Surg Today 2001; 30:268-71. [PMID: 10752781 DOI: 10.1007/s005950050057] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fistulae between the hepatic artery and portal vein, known as hepatoportal arteriovenous fistula (HPAVF), most commonly occur secondary to trauma or malignancy. Congenital HPAVF is an extremely rare anomaly and only 11 pediatric cases have been documented to date HPAVF causes portal hypertension with the reversal of flow in the portal circulation, leading to hyperemia and congestion of the bowel, causing severe ascites, gastrointestinal bleeding, anemia, and malabsorption. The diagnosis is first made by Doppler sonography, then confirmed by angiography. HPAVF is most effectively treated by performing either ligation of the hepatic artery or percutaneous transcatheter embolization. We describe herein the case of an 8-month-old boy diagnosed to have congenital HPAVF by duplex Doppler sonography and confirmed by digital subtraction angiography, who was successfully managed by percutaneous transcatheter embolization of the feeding right hepatic artery. A review of the previously reported 11 cases of infants with this unusual anomaly, examining presentation, management, and outcome, is also presented.
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Affiliation(s)
- S Agarwala
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi
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Abstract
There is a remarkable diversity of conditions encompassed by benign liver masses in infants and toddlers. The most common benign hepatic tumor in this age group is infantile hepatic hemangioendothelioma. Other commonly seen benign tumors are mesenchymal hamartoma and focal nodular hyperplasia. Hepatic adenoma is almost exclusively a disease of older children; primary hepatic teratoma is exceedingly rare. There are several distinguishing characteristics of these benign tumors on radiographic evaluation; however, imaging techniques such as ultrasound scan, computed tomography, and angiography are not always reliable in differentiating benign from malignant tumors. The differential diagnosis of benign hepatic tumors includes nonneoplastic cystic masses including biliary and simple hepatic cysts, hematoma, parasitic cysts, and pyogenic and amebic liver abscess. Choledochal cyst presents with a classic triad of abdominal pain, cholestatic jaundice, and a palpable abdominal mass. They are classified anatomically into 5 subtypes with the most popular types being type I and type IV. Treatment is with complete cyst excision with hepaticojejunostomy reconstruction.
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Affiliation(s)
- R L Meyers
- Department of Surgery, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, USA
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11
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Lamireau T, Chateil JF, Petit P, Portier F, Panuel M, Grenier N. Successful embolization of congenital intrahepatic arterioportal fistula in two infants. J Pediatr Gastroenterol Nutr 1999; 29:211-4. [PMID: 10435662 DOI: 10.1097/00005176-199908000-00021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- T Lamireau
- Department of Pediatrics, Hôpital Pellegrin, Bordeaux, France
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12
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Marchand V, Uflacker R, Baker SS, Baker RD. Congenital hepatic arterioportal fistula in a 3-year-old child. J Pediatr Gastroenterol Nutr 1999; 28:435-41. [PMID: 10204511 DOI: 10.1097/00005176-199904000-00017] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- V Marchand
- Department of Vascular Radiology, Medical University of South Carolina, Charleston 29403, USA
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