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Updated: Jul 6, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
[Cardiac failure in the newborn. Diagnostic pitfalls]
Ioana Alina Anca1, Beata Acs, Alina Stănescu Popp
1Clinica I Pediatrie "Prof. Dr. A. Rusescu", Facultatea de Medicină, Universitatea de Medicină si Farmacie "C. Davila", Bucureşti.
Insights
Neonatal heart failure (HF) can stem from noncardiac causes like vein of Galen aneurysmal malformation (VGAM). Early diagnosis via head ultrasound and cranial auscultation is crucial when cardiac causes are ruled out.
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.
Abstract:
Echocardiography commonly represents the diagnostic clue in neonatal heart failure (HF). Congenital heart diseases are the most frequent causes of HF in this age group. Arterio-venous malformations are the most common noncardiac causes of HF. Normal cardiac structural findings on echocardiography require further investigations in order to exclude other causes of HF. We present three male patients admitted in the interval 2003-2007 with neonatal HF, systolic murmur, cardiomegaly, normal cardiac structure on echocardiography and intracranial bruit. All three cases were diagnosed with vein of Galen aneurysmal malformation (VGAM) by head ultrasound. According to age and malformation type, different presentation patterns were noticed: early neonatal intractable HF mimicking aortic coarctation, postnatal HF stabilized by drug treatment, and chronic HF in a VGAM with tendency to spontaneous regression. Both head ultrasound and cranial auscultation are mandatory in newborns or infants with no cardiac primary cause of HF.
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