Anesthetic management of a neonate with vein of Galen aneurysmal malformations and severe pulmonary hypertension.
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.
Ashida
Yuki
Y
Department of Anesthesiology, Mie University School of Medicine, Mie, Japan.
Miyahara
Hiromi
H
Sawada
Hirohumi
H
Mitani
Yoshihide
Y
Maruyama
Kazuo
K
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
D014665:Vasodilator Agents; D009569:Nitric Oxide