Tricuspid regurgitation and left ventricular eccentricity as a measure of heart failure in the newborn patient with a vein of Galen malformation: illustrative case.
| Title: | Tricuspid regurgitation and left ventricular eccentricity as a measure of heart failure in the newborn patient with a vein of Galen malformation: illustrative case. |
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| Authors: | Yarden JA; Departments of1Neurosurgery.; Hauck LI; Departments of1Neurosurgery.; Athavale KV; 2Pediatrics/Neonatology, and.; McCrary AW; 3Pediatric Cardiology, Duke University, Durham, North Carolina.; Campbell MJ; 3Pediatric Cardiology, Duke University, Durham, North Carolina.; Hauck EF; Departments of1Neurosurgery. |
| Source: | Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2022 Oct 10; Vol. 4 (15). Date of Electronic Publication: 2022 Oct 10 (Print Publication: 2022). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: American Association of Neurosurgeons dba Journal of Neurosurgery Publishing Group Country of Publication: United States NLM ID: 9918227275606676 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 2694-1902 (Electronic) Linking ISSN: 26941902 NLM ISO Abbreviation: J Neurosurg Case Lessons Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Charlottesville, VA] : American Association of Neurosurgeons dba Journal of Neurosurgery Publishing Group, [2021]- |
| Abstract: | Background: Successful management of a vein of Galen malformation (VoGM) in the newborn patient requires a highly coordinated team approach involving neonatologists, pediatric cardiologists, pediatric neurologists, neurosurgeons, and interventionalists. Indication and timing of catheter intervention are topics of ongoing debate.; Observations: The authors highlighted two key echocardiographic markers believed to be practical indicators regarding the need for urgent catheter embolization in neonates with a VoGM. The first and preferred parameter was the tricuspid valve regurgitation (TR) gradient, an estimate of pulmonary artery hypertension. If the TR gradient exceeds systolic blood pressure (suprasystemic pulmonary hypertension [PH], i.e., >60 mm Hg), urgent intervention should be considered in eligible newborns. The second parameter was the left ventricular end-systolic eccentricity index (EI), a newly emerging echocardiographic marker and indirect correlate of PH. As an alternative to the TR gradient, an increased eccentricity index (>1.6) suggests severe right heart compromise, requiring emergency catheter embolization of the malformation. Postoperatively, the progressive reduction of both the TR gradient and the EI correlated with recovery.; Lessons: In eligible newborns, urgent embolization of a VoGM is recommended in the presence of suprasystemic TR gradients and/or increased EI >1.6. |
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| Contributed Indexing: | Keywords: TR gradient; eccentricity index; embolization; newborn; vein of Galen malformation |
| Entry Date(s): | Date Created: 20221203 Latest Revision: 20221213 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC9552681 |
| DOI: | 10.3171/CASE22323 |
| PMID: | 36461836 |
| Database: | MEDLINE |
Journal Article