Endovascular Treatment Can Increase Chance of Survival in Newborns With VGAM, Study Finds

Endovascular embolization — a minimally invasive surgery that cuts off blood flow from a specific group of blood vessels in the body — can increase the chances of survival in babies with vein of Galen aneurysmal malformation (VGAM) and severe pulmonary hypertension (PH), a study reports.

Findings from the study, “Outcomes of endovascular treatment of vein of galen aneurysmal malformation in neonates,” were presented at the 17^th Annual Meeting of the Society of NeuroInterventional Surgery, held online Aug. 4–7.

VGAM is a rare and severe type of arteriovenous malformation — an abnormal connection between veins and arteries that can disrupt blood flow in a specific region of the body — that develops before birth.

Babies with this congenital abnormality lack small blood vessels responsible for distributing blood in the brain, resulting in an increase of blood pressure in the vein of Galen, one of the largest veins that carries blood from the brain to the heart. If not treated, this increased blood pressure can lead to heart failure and be fatal.

Endovascular embolization is a new surgery for VGAM that uses a special liquid material to seal the tangled blood vessels found near the vein of Galen to normalize blood flow and lower blood pressure.

Investigators from the Meshalkin National Medical Research Center in Russia carried out a study to analyze the clinical outcomes of babies with VGAM who received endovascular embolization in their first days of life.

From the 52 babies who had surgery for VGAM at the center between January 2013 and February 2020, 11 underwent the procedure before they were 10 days old.

Before surgery, all babies underwent imaging tests — cardiac ultrasonography to assess different blood flow parameters, and neurosonography to measure pressure inside blood vessels of the heart and brain.

In this case, cardiac ultrasonography was used to measure blood pressure inside the pulmonary artery, which is the artery that connects the heart to the lungs, while neurosonography was used to measure blood flow speed in the vein of Galen and nearby vessels.

Test results revealed that all of the babies in the study had high blood pressure in their pulmonary artery, a hallmark of PH, and their blood circulated faster than 0.6 m/s in their vein of Galen.

Endovascular embolization was performed to try and lower blood flow speed in the vein of Galen by 25%–50% in all infants. Apart from one infant who had a specific subtype of VGAM, a significant reduction in blood pressure in the pulmonary artery was seen in 10 babies shortly after surgery.

“This technique reduces the severity of pulmonary hypertension, thus lowering the risk for developing critical heart failure or multiple organ failure and allows babies to cross the critical line on their way to survival,” Kirill Orlov, MD, lead author of the study, said in a press release.

Eight (72.7%) of these infants were found to have favorable clinical outcomes, while two (18.8%) developed complications following surgery, which were both caused by internal bleeding in the brain (intracranial hemorrhage). Two babies who had surgery died.

Based on the results, the team suggested that “endovascular treatment of vein of Galen aneurysmal malformations in neonates with severe pulmonary hypertension is feasible.”

Nonetheless, “to be treated using endovascular surgery, patients need to undergo meticulous selection,” the team noted.