[Cardiac failure in the newborn. Diagnostic pitfalls]

Area of Science:

• Neonatal cardiology
• Pediatric neurology
• Vascular malformations

Background:

• Neonatal heart failure (HF) is often attributed to congenital heart diseases.
• Noncardiac causes, such as arteriovenous malformations, are significant contributors to HF in neonates.
• Normal echocardiograms in neonates with HF necessitate investigation for alternative etiologies.

Observation:

• Three male infants presented with neonatal HF, systolic murmur, cardiomegaly, and normal echocardiographic findings.
• All cases exhibited intracranial bruit, prompting further investigation.
• Head ultrasound confirmed vein of Galen aneurysmal malformation (VGAM) as the underlying cause in all three patients.

Findings:

• VGAM presented with varied clinical patterns depending on age and malformation severity.
• Presentations ranged from intractable HF mimicking aortic coarctation to chronic, spontaneously regressing HF.
• One case showed postnatal HF that was managed effectively with drug treatment.

Implications:

• Cranial auscultation and head ultrasound are essential in neonates with unexplained HF.
• Identifying VGAM is critical for appropriate management and improved outcomes in affected infants.
• This highlights the importance of considering noncardiac etiologies in neonatal heart failure.