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Pediatrics Conference 2018
Journal of Pediatric Care
ISSN: 2471-805X
Page 32
March 26-27, 2018
Edinburgh, Scotland
2
nd
Edition of International Congress on
Pediatrics
I
ntracranial arteriovenous malformations rarely cause
pulmonary hypertension and congestive heart failure in the
newborn. Their diagnosis is, however, challenging because
cardiomegaly may suggest an intracardiac structural lesion.
Introduction:
Congenital arteriovenous malformations
(AVM s) are structural abnormalities resulting from arrest
in normal morphogenetic processes leading to absence of
normal intervening capillary bed between artery and veins so
blood rushes from the artery type vessel to vein type vessel
without being slowed down by capillaries, which may give
rise to hemodynamic symptoms. The hemodynamic signs
and symptoms produced by systemic AVMs are determined
by their location (brain, liver, thorax, extremities ...) size, and
the patient’s age (as hydrops fetalis during fetal life, neonatal
congestive heart failure, or beyond infancy as a hyperkinetic
circulatory state) Small cranial AVMs may cause no symptom
until they rupture causing signs of cerebral or subarachnoid
hemorrhage. Other manifestations would be neurological
problems such as hydrocephalus, seizure, headache, and
numbness in one part of body paralysis or loss of speech,
memory or vision. Arteriovenous malformation of the vein
of Galen in infancy is a rare cause of neonatal heart failure.
Symptoms of high-output congestive heart failure due to
unique cardiovascular hemodynamics of neonate (patency
of ductus arteriosus and foramen ovale, elevated pulmonary
vascular resistance, and relative hypertrophy and diminished
compliance of right ventricle) may lead to miss diagnosis of
intracardiac defect.
Method:
In this case report we introduce two neonates which
were referred to our hospital (as tertiary cardiac referral center)
due to cardiac failure and were though to suffer from congenital
heart defect. In fact cardiac symptoms in these cases were
secondary to cranial AVM .Echocardiography helped us to
reach the correct diagnosis. Our aims in reporting these two
cases are contributing to medical knowledge, clinical practice,
precise using diagnostic instruments (echocardiography),
disease management, and follow-up. Also we believe on its
educational value.
Case description:
A two-day-old male and eleven-day-
old female newborns with intracranial arteriovenous
malformations and misdiagnosis of congenital heart disease
are presented here.
Discussion:
Infants with severe congestive heart failure caused
by an intracranial AVM are critically ill, and prompt diagnosis
is essential. Two-dimensional ultrasonography of the heart
and brain provides a rapid, efficient method for the detection
of intracranial AVMs. Alongside the complex adjustments
that occur on conversion to extrauterine circulation, the
newborn infant with a large intracranial AVM has an additional
circulatory burden. Shortly after birth, when the pulmonary
vascular resistances are still elevated, the decrease in the total
systemic vascular resistance caused by the presence of a large
AVM promotes right-to-left ductal shunting. The large venous
return to the right atrium from the AVM augments the right-to-
left atrial shunting. An increased blood flow to a low-resistance
fistula leads to the dilatation of the ascending aorta and carotid
arteries, and an increased venous return from the AVM causes
the dilatation of the superior vena cava, right atrium, and right
ventricle. Doppler examination of the descending aorta shows
evidence of a retrograde diastolic flow
Conclusion:
Cranial AVMs cause volume overloading and
cyanosis due to a persistent fetal circulation. Most of cranial
AVM infants are initially deemed to have congenital heart
disease. Careful echocardiography, by demonstrating a normal
intracardiac anatomy via two-dimensional mode and the “steal”
of blood in the cranial region by pulsed and color Doppler
modes, helped us reach the correct diagnosis promptly. It
should be emphasized that cranial auscultation, albeit an
integral component of physical examination in children, more
often than not tends to be ignored.
Aortic Runoff as a Sign of Intracranial Arteriovenous
Malformation
Maryam Moradian
Medical and Research Center- IUMS, Iran
Maryam Moradian, J Pediatr Care, Volume 4
DOI: 10.21767/2471-805X-C1-005