Hemodynamic disturbances associated with endovascular embolization in newborn infants with vein of Galen malformation.
OBJECTIVE
To examine hemodynamic changes following endovascular embolization in newborn infants with vein of Galen malformation and severe cardiac failure in the first week of life.


METHODS
Over a recent 5-year period, nine such infants were identified. In seven of these infants, changes in arterial blood pressure were analyzed in relation to the timing of embolization procedures.


RESULTS
A significant increase in arterial blood pressure was noted after most embolizations. In two infants, this systemic hypertension was severe and treated using intravenous antihypertensive drugs. Both infants subsequently developed complete infarction of both cerebral hemispheres with sparing of the brainstem and cerebellum. Mortality in the nine infants was 33%, and 83% of the survivors were neurologically normal or near normal at follow-up.


CONCLUSIONS
The systemic hypertension observed following endovascular embolizations may provide a protective mechanism to maintain cerebral blood flow after reperfusion injury. Lowering blood pressure in this situation may therefore be detrimental.
Wong
F Y
FY
Department of Neonatology, The Royal Children's Hospital, Melbourne, Australia. flora.wong@med.monash.edu.au
Mitchell
P J
PJ
Tress
B M
BM
Dargaville
P A
PA
Loughnan
P M
PM
D001164:Arteriovenous Fistula / Q000150:complications / Q000151:congenital*; D001794:Blood Pressure / Q000502:physiology; D002544:Cerebral Infarction / Q000209:etiology; D002550:Cerebral Veins / Q000002:abnormalities*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology*; D007231:Infant, Newborn; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies