title: Anesthetic management of a neonate with vein of Galen aneurysmal malformations and severe pulmonary hypertension.
abstract: Vein of Galen aneurysmal malformations (VGAMs) are rare congenital vascular malformations and excessive arteriovenous shunt causes intractable congestive high-output heart failure in the neonate. We report a case of successful staged transcatheter embolizations for a neonate with congestive heart failure and pulmonary hypertension (PH). Heart failure was dramatically relieved as the staged procedure progressed. Although transcatheter embolizations is essential for the treatment, inhaled nitric oxide (iNO) was helpful as a bridge treatment to reduce right-to-left shunt before the initial emergency embolization. Endovascular embolization is a less invasive therapy than open cranial surgery and allows hemodynamic stability. Perioperative iNO can be used to manage PH in VGAMs.
authors.affiliation: Department of Anesthesiology, Mie University School of Medicine, Mie, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ashida
authors.forename: Hiromi
authors.initials: H
authors.lastname: Miyahara
authors.forename: Hirohumi
authors.initials: H
authors.lastname: Sawada
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Mitani
authors.forename: Kazuo
authors.initials: K
authors.lastname: Maruyama
mesh_terms: D000280:Administration, Inhalation; D000768:Anesthesia, General; D002550:Cerebral Veins / Q000601:surgery*; D004621:Embolization, Therapeutic; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000628:therapy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000628:therapy; D007231:Infant, Newborn; D002532:Intracranial Aneurysm / Q000150:complications* / Q000151:congenital / Q000601:surgery*; D009569:Nitric Oxide / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide