title: Superior vena cava flow and management of neonates with vein of Galen malformation.
abstract: OBJECTIVE
  Vein of Galen malformation (VGAM) in neonates presents a complex management challenge. Measurement of superior vena cava (SVC) blood flow may provide insights into the haemodynamics of VGAM and the effects of therapeutic intervention.
  
  
  METHODS
  SVC flow was assessed in 15 neonates with VGAM. SVC flow results, Bicêtre scores (clinical assessment), echocardiographic assessment and clinical outcomes are presented.
  
  
  RESULTS
  SVC flows (166-581 ml/kg/min) were significantly elevated at presentation (p<0.001; normal range 55-111 ml/kg/min). Endovascular intervention was undertaken in 12 cases, with nine survivors. SVC flows decreased sequentially with each embolisation, with a median SVC flow at discharge of 124 ml/kg/min (IQR 79-155 ml/kg/min). All cases with SVC flow >400 ml/kg/min (n=5) had an adverse outcome (death or profound neurological damage). Cases with SVC flow <400 ml/kg (n=10) required embolisation before discharge at a median age of 6 days. There were no survivors with Bicêtre scores <8 (n=2) but the predictive value of early Bicêtre score was poor.
  
  
  CONCLUSIONS
  SVC flow measurements provide insight into the haemodynamic challenges of VGAM and provide additional useful prognostic information.
authors.affiliation: Department of Neonatal Medicine, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK. anemarie.heuchan@nhs.net
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Heuchan
authors.forename: Jo
authors.initials: J
authors.lastname: Bhattacharyha
mesh_terms: D001011:Aorta / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009102:Multiple Organ Failure / Q000503:physiopathology; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler; D054080:Vein of Galen Malformations / Q000503:physiopathology* / Q000628:therapy*; D014683:Vena Cava, Superior / Q000503:physiopathology*