HEART FAILURE IN INFANCY DUE TO ARTERIOVENOUS MALFORMATION OF THE VEIN OF GALEN

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Abstract
An infant with heart failure secondary to an arteriovenous malformation of the vein of Galen is described. The onset of congestive failure began at the age of 3 mon. The diagnosis of an arteriovenous fistula was established by cerebral arteriography at the age of 6 months. The diagnosis was suggested by the presence of hydrocephalus and a cranial bruit. Surgical correction was attempted at 6 1/2 months of age, but the infant died of ventricular fibrillation. The literature on vein of Galen malformations is reviewed with respect to those patients with heart failure. Seventeen patients with heart failure secondary to this lesion have been reported; 13 were neonates and 3 were infants of of 1, 4, and 7 mon. of age. Fourteen patients died in heart failure, 2 died following surgery, and only 1 survived. The mechanism of heart failure in intracranial arteriovenous malformations is poorly understood, but involves increased cardiac output and hypervolemia. The syndrome of congestive heart failure, hydrocephalus, and cranial bruit should suggest the diagnosis of an aneurysm of the vein of Galen. This diagnosis should always be considered in neonates and infants with heart failure of obscure etiology.