| Severe cardiac failure in newborns with VGAM. Prognosis significance of hemodynamic parameters in neonates presenting with severe heart failure owing to vein of Galen arteriovenous malformation. | |
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MedLine Citation:
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PMID: 12185436 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Neonatal vein of Galen malformation complicated by severe cardiac failure is a rare disease. The purpose was to assess the outcome of this life-threatening malformation and identify hemodynamic prognostic factors. DESIGN: Retrospective study. PATIENTS: Twenty-four newborns with cardiac failure requiring mechanical ventilation were consecutively admitted from 1986 to 2000. INTERVENTIONS: Cardiovascular evaluation including echocardiogram was performed in all cases. Eighteen transarterial shunt occlusions with glue were applied by the same team of three physicians. MEASUREMENTS AND RESULTS: Twelve babies survived and underwent one endovascular session at least (median age 20 days) with a mean 63 months follow-up. Embolization was not performed in 6 of the 12 nonsurvivors because of severe brain damage or profound hypotension Cardiogenic shock occurred in all nonsurvivors, but also in one long-term survivor (p<0.0001). Echocardiogram showed signs of right ventricular failure, most often in the dead babies (p=0.005). The pulmonary systemic arterial pressure ratio was significantly higher in the nonsurvivor group (p=0.031), and it decreased significantly after the first embolization only in patients who survived (p=0.01). Patent ductus arteriosus and a diastolic aortic reversed-flow were present in all nonsurvivors in contrast to 30% of the long-term survivors (p=0.003 ). There was no difference in the left ventricular contractility and mean cardiac output between the two groups. CONCLUSIONS: The outcome of vein of Galen malformation complicated by severe cardiac failure requiring mechanical ventilation remains poor. Neonatal embolization seems to be beneficial only in babies without suprasystemic pulmonary hypertension. |
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Authors:
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L Chevret; P Durand; H Alvarez; V Lambert; L Caeymax; G Rodesch; D Devictor; P Lasjaunias |
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Publication Detail:
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Type: Journal Article Date: 2002-07-05 |
Journal Detail:
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Title: Intensive care medicine Volume: 28 ISSN: 0342-4642 ISO Abbreviation: Intensive Care Med Publication Date: 2002 Aug |
Date Detail:
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Created Date: 2002-08-19 Completed Date: 2002-12-11 Revised Date: 2009-11-03 |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1126-30 Citation Subset: IM |
Affiliation:
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Service de Réanimation, Hopital de Bicêtre, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Arteriovenous Malformations
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physiopathology*,
ultrasonography Cardiac Output, Low / complications, physiopathology* Cerebral Veins / abnormalities*, ultrasonography Critical Illness* Embolization, Therapeutic Female France Hemodynamics* Humans Infant, Newborn Intensive Care Units, Neonatal Male Prognosis Rare Diseases Respiration, Artificial Retrospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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