Quantified Partial Embolisation in a Vein of Galen Malformation with Congestive Cardiac Failure

Abstract

The aim of the study was to quantify embolisation in a vein of Galen malformation by intraluminal measurements of flow velocities in the feeding vessels and to test a new O.014-inch Doppler guide wire in the paediatric population. The examination was performed in a seven month old boy who presented with a vein of Galen malformation combined with congestive cardiac failure from birth. The measurements showed a decrease of the systolic and diastolic velocities and an increase in the effective downstream vascular resistance after closure of the high flow fistula. The decrease of the diastolic velocities after embolisation was more prominent because of the reduction of the sump effect responsible for the high diastolic velocity before embolisation. The reduction of about 40% of the vein of Galen malformation estimated with morphological criteria was associated with a decrease of the diastolic velocity in the basilar artery of about 50%. The clinical improvement led to the discontinuance of most of the cardiac treatment over a few days. These measurements seem to offer the possibility to assess the necessary reduction of the shunt to relieve CCF in a vein of Galen malformation.