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Di Meglio L, Sica G, Toscano P, Orlandi G, Manzo L, Mazzarelli LL, Sica C, Di Meglio A. A systematic review of prenatally diagnosed vein of Galen malformations: prenatal predictive markers and management from fetal life to childhood. Front Pediatr 2024; 12:1401468. [PMID: 39022219 PMCID: PMC11251923 DOI: 10.3389/fped.2024.1401468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/03/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Vein of Galen malformations (VGMs) account for less than 1% of all intracranial vascular malformations. However, in fetal and pediatric populations, they represent the most common vascular malformation of the brain. For the effective management of this condition, an optimal knowledge of its prenatal and postnatal clinical features is mandatory. Methods Articles published between 1 January 2003 and 31 January 2024, reported in PubMed and EMBASE, were evaluated for a systematic review analyzing the prenatal and postnatal features and management of fetal VGMs. Results Thirty-one papers reporting information on 51 prenatally diagnosed VGMs were included. The most common prenatal features were fetal hydrocephalus (39%) and cardiomegaly (56%). Postnatal data for 43 VGM cases are described. The overall mortality was 58.14%. In total, 77.78% of the survivors had normal development. Conclusions Close follow-up and a multidisciplinary approach are mandatory to manage this condition. Our study aimed to provide a guide for gynecologists, neonatologists, cardiologists, and neuroradiologists.
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Affiliation(s)
- Lavinia Di Meglio
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Giordana Sica
- University of Medicine and Surgery Luigi Vanvitelli, Naples, Italy
| | - Paolo Toscano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine and Surgery Federico II of Naples, Naples, Italy
| | - Giuliana Orlandi
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine and Surgery Federico II of Naples, Naples, Italy
| | - Luigi Manzo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine and Surgery Federico II of Naples, Naples, Italy
| | - Laura Letizia Mazzarelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine and Surgery Federico II of Naples, Naples, Italy
- Diagnositica Ecografia e Prenatale di A. Di Meglio, Naples, Italy
| | - Carmine Sica
- Diagnositica Ecografia e Prenatale di A. Di Meglio, Naples, Italy
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2
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Tawfiq A, Alsabban Z, Baradwan S. Multidisciplinary care of fetal vein of Galen arteriovenous malformation diagnosed via Doppler ultrasound and magnetic resonance imaging: A case report. Case Rep Womens Health 2024; 42:e00615. [PMID: 38746059 PMCID: PMC11092392 DOI: 10.1016/j.crwh.2024.e00615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
Fetal vein of Galen malformation (VOGM) represents a rare congenital anomaly affecting the fetal cerebral vasculature. A 27-year-old Middle Eastern woman was referred due to intrauterine growth restriction (IUGR) and fetal cardiac anomalies identified at 35 weeks of gestation. The diagnosis of fetal VOGM with dilated neck vessels was established through a combination of color Doppler ultrasonography and magnetic resonance imaging. A multidisciplinary approach involving maternal-fetal medicine, neonatology, pediatric cardiology, and interventional radiology was implemented. Given the grave prognosis for the baby, the patient received comprehensive counseling. Subsequent monitoring revealed a non-reassuring fetal heart trace, prompting the decision to perform a cesarean section. The newborn, a girl, was admitted to the neonatal intensive care unit for further management but she died shortly thereafter, with heart failure and intracranial hemorrhage identified as the probable causes of death. In summary, the diagnosis and management of VOGMs demand specialized expertise and a collaborative, multidisciplinary approach to optimize patient care and outcomes.
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Affiliation(s)
- Afaf Tawfiq
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Zehour Alsabban
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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3
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Ivanov K, Atsev S, Petrov PP, Ilyov I, Penchev P. Epileptic Seizures in a Pediatric Patient With Vein of Galen Aneurysmal Malformation and Obstructive Hydrocephalus: A Rare Case Report. Cureus 2024; 16:e56962. [PMID: 38665762 PMCID: PMC11044896 DOI: 10.7759/cureus.56962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The vein of Galen aneurysmal malformation (VGAM) is a rare congenital arteriovenous fistula of the embryonic median prosencephalic vein of Markowski, resulting in its pathological dilation. If left untreated, it can lead to multiple severe complications in the neonatal period, among which obstructive hydrocephalus. We present a case report of a six-year-old male patient with severe status epilepticus and a clinical history of VGAM and obstructive hydrocephalus, diagnosed via an MRI and an MR-angiography. The hydrocephalus was treated via a ventriculostomy at the age of six months, while the VGAM underwent a partial transarterial endovascular embolization when the patient was four years old. The procedures were successful, and there were no significant post-operative complications observed. The epileptic seizures began at a later point and were successfully medicated with valproate. However, they resumed due to a lowering of the medication dosage by the patient's parents. The patient was given a new valproic acid regimen with an appropriate dosage, and his parents reported no further seizures. This case report emphasizes the use of appropriate prenatal and neonatal diagnostic methods for VGAM and explores the nature of the multi-procedural therapy approach towards the pathology and its complications in relation to a possibly idiopathic co-pathology, namely epilepsy.
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Affiliation(s)
- Kiril Ivanov
- Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | | | - Petar-Preslav Petrov
- Department of Anatomy, Histology and Embryology, Medical University of Plovdiv, Plovdiv, BGR
| | - Ilko Ilyov
- Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | - Plamen Penchev
- Faculty of Medicine, Medical University of Plovdiv, Plovdiv, BGR
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4
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Gillet de Thorey A, Ozanne A, Melki J, Dumery G, Benachi A, Vivanti AJ. State of the art of antenatal diagnosis and management of vein of Galen aneurysmal malformations. Prenat Diagn 2022; 42:1073-1080. [PMID: 35793434 DOI: 10.1002/pd.6203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/09/2022] [Accepted: 06/26/2022] [Indexed: 11/09/2022]
Abstract
Vein of Galen aneurysmal malformation (VGAM) is a severe rare vascular anomaly whose prognosis depends on cerebral and cardiac consequences that can be hard to diagnose, let alone predict in utero. We performed an updated review to summarize current research on the genetics, ultrasound and MRI of VGAM that could help in the diagnosis and management of VGAM. Prenatal diagnosis of VGAM has greatly improved in recent years. Ultrasound allows in utero detection of VGAM in most cases now and is the best exam for prenatal cardiac evaluation. Tricuspid insufficiency is the only cardiac feature associated with poor prognosis. Cardiomegaly may indicate a risk of cardiac failure at birth and should prompt discussion of birth in a specialized facility. Ultrasound can identify constituted cerebral lesions, but MRI diagnoses early signs of cerebral hemodynamic changes, notably through the detection of pseudo-feeders. Genetic exploration should be proposed after VGAM diagnosis. Ultrasound and MRI are essential complementary tools for the diagnosis of VGAM, but also for prognostic evaluation, and provide information for the counseling of parents and optimal management of the pregnancy.
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Affiliation(s)
- Axelle Gillet de Thorey
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Augustin Ozanne
- Department of Interventional Neuroradiology, National Reference Center for Paediatric Neurovascular Malformation, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Judith Melki
- Institut National de la Santé et de la Recherche Médicale (Inserm) UMR-1195, Paris Saclay University, Le Kremlin Bicêtre, France
| | - Grégoire Dumery
- Division of Obstetrics and Gynecology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin Bicêtre, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.,Institut National de la Santé et de la Recherche Médicale (Inserm) UMR-1195, Paris Saclay University, Le Kremlin Bicêtre, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France.,Institut National de la Santé et de la Recherche Médicale (Inserm) UMR-1195, Paris Saclay University, Le Kremlin Bicêtre, France
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5
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Ramdani H, Sahri IE, Elharras Y, Haddad SE, Allali N, Chat L. Vein of Galen aneurysmal malformation presenting as severe heart failure in a neonate. Radiol Case Rep 2021; 16:3961-3964. [PMID: 34745403 PMCID: PMC8551785 DOI: 10.1016/j.radcr.2021.09.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 11/21/2022] Open
Abstract
The vein of Galen aneurysmal malformation (VGAM) is a rare cerebral arteriovenous malformation that can be life-threatening if not diagnosed and treated early. VGAM usually presents in the neonatal period with high-output cardiac failure. We report the case of a full-term male neonate who presented with respiratory distress, and a fontanel bruit soon after birth. A chest radiograph revealed marked cardiomegaly. Transthoracic echocardiography showed dilatation of all four cardiac chambers and a patent ductus arteriosus. Transfontanellar doppler ultrasound and brain computed tomography confirmed the diagnosis of a VGAM. Clinical worsening took place despite aggressive hemodynamic and ventilatory support. The patient's Bicêtre Neonatal Evaluation Score for embolization was 2. Endovascular treatment could not be performed. The patient regretfully passed away. VGAM should be considered in the differential diagnosis of neonatal congestive heart failure with a structurally normal heart. Early diagnosis and treatment improve prognosis considerably.
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Affiliation(s)
- Hanae Ramdani
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
- Corresponding author.
| | - Imad-eddine Sahri
- Neurosurgery department - Mohammed Vth military hospital-Rabat, Ryad street-10010 Rabat, MOROCCO
| | - Yahya Elharras
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
| | - Siham El Haddad
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
| | - Nazik Allali
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
| | - Latifa Chat
- Radiology department, Childrens’ hospital - Ibn Sina university hospital-Rabat, Lamfadel Cherkaoui street-10010 Rabat, MOROCCO
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Shabana H, Leidinger J, Wikström J, Axelsson O. Prenatal findings and postnatal follow-up of a midline dural sinus malformation. Acta Radiol Open 2021; 10:20584601211006315. [PMID: 33889426 PMCID: PMC8040577 DOI: 10.1177/20584601211006315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 12/01/2022] Open
Abstract
Dural sinus malformation is a rare condition. We describe a prenatally detected case followed by repeated ultrasound scans and a prenatal magnetic resonance imaging examination. A substantial spontaneous regression was observed, which is associated with a favorable outcome. We believe that our observations, including a long postnatal follow-up, will add to the present knowledge of prenatally detected cases, and thus improve management of the pregnancies as well as our possibilities to counsel the parents-to-be.
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Affiliation(s)
- Hana Shabana
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Obstetrics and Gynecology, Nyköping Hospital, Nyköping, Sweden
| | - Johannes Leidinger
- Department of Obstetrics and Gynecology, Mälar Hospital, Eskilstuna, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Ove Axelsson
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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7
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Neacsu A, Herghelegiu CG, Voinea S, Dimitriu MCT, Ples L, Bohiltea RE, Braila AD, Nastase L, Bacalbasa N, Chivu LI, Furtunescu F, Ioan RG. Umbilical cord lactate compared with pH as predictors of intrapartum asphyxia. Exp Ther Med 2020; 21:80. [PMID: 33363591 DOI: 10.3892/etm.2020.9513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.
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Affiliation(s)
- Adrian Neacsu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Ioan' Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Cătălin Gabriel Herghelegiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
| | - Silviu Voinea
- Department of Surgery, Institute of Oncology 'Prof. Dr. Alexandru Trestioreanu', 020122 Bucharest, Romania
| | - Mihai Cornel Traian Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics-Gynecology, 'Sf. Pantelimon' Emergency University Hospital, 021623 Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, Bucur Maternity Hospital, 012361 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Anca Daniela Braila
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Leonard Nastase
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Laura Ioana Chivu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pathophysiology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Raluca Gabriela Ioan
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Alessandrescu-Rusescu' National Institute for Healthcare of Mother and Child, 020395 Bucharest, Romania
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8
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Turcan N, Bohiltea RE, Ionita-Radu F, Furtunescu F, Navolan D, Berceanu C, Nemescu D, Cirstoiu MM. Unfavorable influence of prematurity on the neonatal prognostic of small for gestational age fetuses. Exp Ther Med 2020; 20:2415-2422. [PMID: 32765726 PMCID: PMC7401915 DOI: 10.3892/etm.2020.8744] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
Vascular stress at the level of the uterus-placental unit, with chronic placental ischemia, results in intrauterine growth restriction. Expectation management can be used, when the situation allows, in cases of compensated intrauterine growth restriction. The aim of the present study was to evaluate the neonatal prognosis of preterm births with and without growth restriction and term births with growth restriction in order to improve decisional accuracy regarding the termination of pregnancy. The frequency of term birth infants with low birth weight for gestational age was ~2%. The male sex, predominated only in the group of premature infants with normal weight for the gestational age. The highest frequency of neonatal complications studied occurred in the group of preterm neonates small for gestational age (SGA) with statistical significance obtained for cardiovascular arrest acute respiratory failure, ulcer-necrotic enterocolitis, respiratory distress, cerebral edema, intraventricular hemorrhage, cerebral hemorrhage, pulmonary hemorrhage, neonatal infection, hypoglycemia, retinopathy, anemia, hemorrhagic disease, disseminated intravascular coagulation, disease of hyaline membranes, neonatal sepsis, need for intensive neonatal therapy and death. In conclusion, immediate neonatal adaptation of SGA preterm neonates is more deficient than for preterm neonates with appropriate weight for gestational age; the adaptation of preterm neonates, in turn, is more deficient than term newborns with intrauterine growth restriction. The term newborns with intrauterine growth restriction have a neonatal adaptation comparable to that of the term newborns with weight corresponding to the gestational age.
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Affiliation(s)
- Natalia Turcan
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy Doctoral School, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Florentina Ionita-Radu
- Department of Gastroenterology, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine,‘Carol Davila’ University of Medicine and Pharmacy, 050463 Bucharest
| | - Dan Navolan
- Department of Obstetrics and Gynecology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Costin Berceanu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, ‘Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Monica Mihaela Cirstoiu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
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9
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Herghelegiu CG, Duta SF, Neacsu A, Suciu N, Veduta A. Operator experience impact on the evaluation of still images of a first trimester cardiac assessment protocol. J Matern Fetal Neonatal Med 2020; 35:1957-1961. [PMID: 32498650 DOI: 10.1080/14767058.2020.1774873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective: Congenital heart disease (CHD) is the most common birth defect and represents the leading cause for mortality and morbidity in infants and young adults. Early fetal echocardiography is usually considered a highly specialized scan. The goal of this study is to evaluate the impact of operator's experience in assessing still images of the 4-chamber view and 3-vessels view and to evaluate the feasibility and the performance of a first trimester screening protocol for CHD.Methods: An online questionnaire consisting of still images of the 4-camber view and 3-vessel view from 50 normal and abnormal cases was reviewed by an expert group made of seven obstetricians specialized in fetal medicine and a nonexpert group made of 13 obstetricians that are certified in ultrasound. After individually visualizing each image set made of the 4-chamber view and 3-vessel view, they had to conclude if the case was normal or abnormal and what images were abnormal.Results: A total of 50 image sets of both normal and abnormal fetal hearts were examined by the 20 reviewers, resulting in 1000 evaluations. The expert group achieved a detection rate of 97.1% with a false positive rate of 5.7%. The nonexpert group achieved also a good detection rate of 91.3% but with a much higher false positive rate of 33.9%. The most frequently missed CHD involved the great arteries and had a normal 4-chamber view. In the majority of false positive cases the 3-vessel view was incorrectly interpreted as abnormal.Conclusions: A screening protocol for CHD, based on the 4-chamber view and 3-vessel view alone can offer a good detection rate for CHD with a small false positive rate, but only if it is implemented by highly specialized sonographers.
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Affiliation(s)
- Catalin Gabriel Herghelegiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,INSMC "Alessandrescu Rusescu", Bucharest, Romania
| | | | - Adrian Neacsu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Obstetrics and Gynecology, "St. John" Emergency Clinical Hospital, Bucharest, Romania
| | - Nicolae Suciu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,INSMC "Alessandrescu Rusescu", Bucharest, Romania
| | - Alina Veduta
- "Filantropia" Clinical Hospital, Bucharest, Romania
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10
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Kojmane W, Hmami F, Atmani S. An unusual cause of cardiac failure in a neonate. Arch Pediatr 2019; 26:176-178. [PMID: 30827772 DOI: 10.1016/j.arcped.2019.02.004] [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: 06/04/2018] [Revised: 11/26/2018] [Accepted: 02/03/2019] [Indexed: 11/29/2022]
Abstract
We report the case of a newborn admitted with signs of congestive cardiac failure with prominent and pulsatile cervical veins. Echocardiography showed a structurally normal heart, right-to-left ductal flow, and reversed diastolic flow in the proximal descending aorta. A computed-tomography scan of the head showed a vein of Galen arteriovenous malformation. This highlights the importance of considering an intracranial cause in the differential diagnosis of neonatal congestive heart failure.
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Affiliation(s)
- W Kojmane
- Service de réanimation néonatale, CHU Hassan II-Fès, université Sidi Mohamed Ben Abdellah, 30000 Fès, Morocco.
| | - F Hmami
- Service de réanimation néonatale, CHU Hassan II-Fès, université Sidi Mohamed Ben Abdellah, 30000 Fès, Morocco
| | - S Atmani
- Service de réanimation néonatale, CHU Hassan II-Fès, université Sidi Mohamed Ben Abdellah, 30000 Fès, Morocco
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11
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Ionescu CA, Calin D, Navolan D, Matei A, Dimitriu M, Herghelegiu C, Ples L. Alobar holoprosencephaly associated with a rare chromosomal abnormality: Case report and literature review. Medicine (Baltimore) 2018; 97:e11521. [PMID: 30024536 PMCID: PMC6086508 DOI: 10.1097/md.0000000000011521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Holoprosencephaly is a structural malformation of the brain that results from the complete or incomplete noncleavage of the forebrain of the embryo into 2 hemispheres. We report a severe case of alobar holoprosencephaly diagnosed at 38 weeks, associated with cebocephaly, microcephaly, and craniosynostosis. PATIENT CONCERN The main knowledge added by this case is the late ultrasound diagnosis and chromosomal analysis that revealed a very rare abnormality (45X/46,XX/47,XX) with mosaicism at chromosome 18. DIAGNOSES Investigation of the mother revealed nothing remarkable from clinical point of view and on laboratory tests. Ultrasonography identified a fetal biometry appropriate for gestational age, except for the head biometry and abdominal circumference, that were appropriate for less than the fifth percentile. Microcephaly, a large midline monoventricle, absent midlinestructures, cleft lip, cebocephaly (hypotelorism, single-nostril nose), ethmocephaly (hypotelorism, interorbital proboscis) and craniosynostosis, were also present. Fetal magnetic resonance imaging of fetus revealed an absent midline structure, a central monoventricle, abnormal corpus calosum, and abnormal gyri. INTERVENTIONS A cesarean section at 38 weeks was indicated for fetal bradycardia and a female baby was delivered, with Apgar score 6, weight 2290g. After birth, the diagnosis of the fetus confirmed holoprosencephaly with facial anomalies and demonstrated repeated tonic-clonic seizure, severe respiratory failure, cyanosis, decreased muscle tone, palor, and apnea. Laboratory examination of the newborn revealed acidosis and a prolonged of prothrombin time. The neonate was treated for severe respiratory distress syndrome, with immediate intubation and resuscitation. Vitamin K, fresh frozen plasma, and antibiotics were also administered. OUTCOMES After delivery, exitus of the fetus occurred at 3 days and 18hours due to massive pulmonary hemorrhage. LESSONS We described a case of alobar holoprosencephaly diagnosed at 38 weeks of gestation and associated with a rare chromosomal abnormality (45X/46,XX/47,XX) with mosaicism at chromosome 18. Emotional implications could have been less severe if the patient underwent regular ultrasonography allowing a diagnosis in the first or early second trimester.
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Affiliation(s)
- Crîngu Antoniu Ionescu
- Department of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Sf Pantelimon Clinical Emergency Hospital, Bucharest
| | - Dan Calin
- Department of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Sf Pantelimon Clinical Emergency Hospital, Bucharest
| | - Dan Navolan
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Victor Babes, Timisoara
| | - Alexandra Matei
- Department of Obstetrics and Gynecology, Sf Pantelimon Clinical Emergency Hospital
| | - Mihai Dimitriu
- Department of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Sf Pantelimon Clinical Emergency Hospital, Bucharest
| | - Catalin Herghelegiu
- Department of Obstetrics, Gynecology and Neonatology, Polizu Clinical Hospital
| | - Liana Ples
- Department of Obstetrics, Gynecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Sf Ioan Emergency Hospital, Bucharest, Romania
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Kassem MW, Choi PJ, Iwanaga J, Mortazavi MM, Tubbs RS. Imaging Characteristics of Dural Arteriovenous Fistulas Involving the Vein of Galen: A Comprehensive Review. Cureus 2018; 10:e2180. [PMID: 29657906 PMCID: PMC5896872 DOI: 10.7759/cureus.2180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vein of Galen aneurysmal malformation (VGAM) is a rare angiopathy, which most commonly presents in infancy. Although very rare, it is associated with high morbidity and mortality rates. In order to minimize such morbid rates, a prompt diagnosis followed by a timely initiation of management is crucial. Multiple antenatal and postnatal imaging techniques for the diagnosis have been described and discussed in the literature. However, to our knowledge, a comprehensive review exploring such a list of imaging options for VGAM has never been established. We aim to review the diagnostic tools to aid in better understanding of the investigative modalities physicians may choose from when treating patients with a VGAM.
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Affiliation(s)
| | - Paul J Choi
- Clinical Anatomy, Seattle Science Foundation
| | | | - Martin M Mortazavi
- California Institute of Neuroscience, Los Robles Hospital and Medical Center
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