Cerebral arteriovenous fistula producing cardiac failure in the newborn infant: Case report and review

Abstract

Summary In the newborn infant, extracardiac causes of congestive failure with associated marked cardiomegaly include: (1) patent ductus arteriosus, (2) hemolytic anemias, (3) multiple telangiectasias of the cerebral vessels, and (4) cerebral arteriovenous aneurysm. The clinical and pathologic findings are presented of a newborn infant who had cardiomegaly, cardiac failure, and at postmortem examination was found to have a cerebral arteriovenous fistula. Congenital cerebral arteriovenous aneurysms most frequently involve the middle cerebral artery. The usual clinical picture is described, and cases with cardiovascular complications in infancy are listed. As a result of lowered peripheral resistance, arteriovenous fistulas are frequently associated with (1) an increased cardiac output, (2) cardiac dilatation, (3) lowering of the diastolic pressure, (4) occasional evidence of myocardial damage on the electrocardiogram, and (5) cardiac failure. The mechanisms for these findings are discussed briefly. While cerebral arteriovenous fistulas are a very rare cause of extracardiac heart failure and gross cardiomegaly in the newborn period, it is pointed out that the possibility should be kept in mind.