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High-output heart failure in a newborn.
Maria Inês Mascarenhas1, Marta Moniz, Sofia Ferreira
1Neonatal Intensive Care Unit, Department of Pediatrics-Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal. ines.mascarenhas@gmail.com
BMJ Case Reports
|July 12, 2012
Summary
A rare condition of high-output cardiac failure in newborns, caused by a brain arteriovenous malformation (AVM), was successfully treated with embolization. This intervention improved cardiac function but resulted in significant neurodevelopmental delays.
Area of Science:
- Neonatal Cardiology
- Pediatric Neurology
- Interventional Neuroradiology
Background:
- High-output cardiac failure is a rare but critical condition in neonates.
- Early diagnosis and intervention are essential for managing neonatal cardiac failure.
Observation:
- A neonate presented with a cardiac murmur on day 1, progressing to cardiac failure by day 3.
- Clinical signs included gallop rhythm, hepatomegaly, and a cranial murmur.
- Echocardiography revealed biventricular dysfunction and cardiac chamber dilation.
Findings:
- Cranial MRI identified a pial arteriovenous malformation (AVM) involving the anterior and middle cerebral arteries.
- An associated fronto-parietal ischemic lesion was noted.
- Embolization of the AVM led to successful flow reduction and improvement in cardiac failure.
Implications:
- Successful AVM embolization can resolve neonatal high-output cardiac failure.
- Despite cardiac recovery, severe neurodevelopmental deficits, including psycho-motor delay and hemiparesia, can persist.
- Multidisciplinary follow-up is crucial for managing long-term neurological sequelae in affected infants.
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