Andreea Gorcea
Institute for Mother and Child Health Alessandrescu-Rusescu, Romania
Title: Early prenatal diagnosis of vein of Galen aneurysm-prognosis factor
Biography
Biography: Andreea Gorcea
Abstract
Statement of Problem: The vein of Galen aneurysm represents a complex malformation including multiple arteriovenous fistulae located at the midline of the brain, close to midbrain. Even rare, VGA is the most common diagnosed vascular prenatal malformation of the brain. In fact, VGA is a persistency and dilatation of the precursor of vein of Galen, the median prosencephalic vein of Markowski.
Methodology: 32 year pregnant woman, G2P1, 23 weeks, was referred to our FMU for an amniocentesis due to an increased nuchal fold at the anomaly scan. The second opinion scan detected a large cystic structure above the thalamus in the midline of the brain, close to the third ventricle, with turbulent color Doppler flow, high velocity/low resistance.
Results: Additional finding was the presence of cardiomegaly as a direct sign of cardiac failure. Taking into account the early gestational age, the magnitude of the shunt and the associated factors (cardiomegaly, enlarged neck veins) the couple was counseled about the poor prognosis due to imminent cardiac insufficiency (early signs), leading to a high rate of intrapartum and postpartum morbidity and mortality or the potential mental and physical impairment.
Conclusion: VGA is a rare condition with high morbidity and mortality rates when associated with other complications/abnormalities. The prognosis is directly linked to these complications. The particularity of the case is the earliest diagnosis of this condition until now (23 weeks), usually diagnosed in the third trimester and the magnitude of the shunt with early signs of cardiac failure.
