Hepatic Arteriovenous Malformation in a Preterm Infant With High-Output Cardiac Failure

Congenital hepatic arteriovenous malformations (HAVM) are rare and serious with a known high mortality rate. They are mostly described in the term population and, if symptomatic, present with early-onset congestive heart failure. To our knowledge, there have been no published cases of an affected very preterm infant. Prenatal diagnosis and preprocedural planning are paramount in these critically ill infants. Strategies for management of HAVM differ depending on the size of both the infant and HAVM as well as severity of symptoms. Management may include supportive pharmacologic therapy, transcatheter embolization, and surgical resection or ligation. In this report, we present the case of a 28-week gestation infant with high-output cardiac failure secondary to prenatally diagnosed hepatic arteriovenous malformation. On day of life 3, the infant underwent successful transcatheter occlusion. However, despite maximal medical management and partial embolization of his HAVM, he did not survive.