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Symptomatic arteriovenous malformation in infants less than 6 months of age
Insights
Early diagnosis and treatment are crucial for infants with symptomatic systemic arteriovenous (A-V) malformations. Combined medical and surgical therapy significantly improves outcomes for these complex pediatric vascular conditions.
Area of Science:
- Pediatric Cardiology
- Vascular Surgery
- Neonatal Medicine
Background:
- Systemic arteriovenous (A-V) malformations in infants under 6 months present significant diagnostic and therapeutic challenges.
- These malformations can affect critical organs including the central nervous system (CNS), liver, and lungs, leading to severe sequelae.
Purpose of the Study:
- To compare the symptoms, diagnostic approaches, treatment strategies, and outcomes of systemic A-V malformations in infants based on the affected organ system.
- To emphasize the importance of early diagnosis and intervention for improving patient outcomes.
Main Methods:
- Retrospective analysis of 156 infants diagnosed with systemic A-V malformations.
- Categorization of patients based on involvement of CNS, liver, or lungs.
- Comparison of clinical presentation, diagnostic findings, therapeutic interventions, and mortality rates across the different groups.
Main Results:
- Central Nervous System (CNS) A-V malformations: 67% presented with congestive heart failure; 64% mortality.
- Hepatic A-V malformations: 67% had abdominal masses, 48% congestive heart failure; 55% mortality.
- Pulmonary A-V malformations: 57% presented with congestive heart failure, 43% cyanosis; 43% mortality.
Conclusions:
- Systemic A-V malformations in infants, particularly those involving the CNS, liver, and lungs, are associated with high morbidity and mortality.
- Early diagnosis and a combined medical and surgical therapeutic approach are essential for improving the prognosis of affected infants.
Abstract:
The symptomatology and sequelae of symptomatic system arteriovenous (A-V) malformations in children less than 6 months old make an early diagnosis possible and early treatment mandatory. A group of 156 infants with systemic A-V malformations involving the CNS (81 infants), liver (61 infants), and lungs (14 infants) were studied to compare symptoms, diagnosis, treatment, and outcome. Congestive heart failure was present in 67% of the patients with CNS A-V malformations. Mortality among the patients with CNS A-V fistulas was 64%. Of those patients with hepatic A-V malformations 67% had abdominal masses, 48% congestive heart failure, and 55% died. Pulmonary A-V malformations presented with congestive heart failure 57%, cyanosis 43%, and resulted in a 43% mortality. Early combined medical and surgical therapy offered the best chance for a successful outcome.