[Severe neonatal cardiac insufficiency due to arteriovenous fistula of the vein of Galen].

The cerebral arteriovenous fistula is a rare cause of neonatal cardiac failure. We have recently observed three cases of severe cardiac failure associated with an arterio-venous malformation of the vein of Galen. At echocardiography and angiography the right cardiac chambers were seen to be more enlarged than the left ones. This may have resulted to some extent from an insufficient right-to-left shunt during foetal life due to a relatively small foramen ovale confronting an increased systemic venous return. Two of the neonates were operated upon and one survived. Based on our experience and on a review of the literature we feel that the diagnostic clues are: 1) severe cardiac enlargement; 2) a vascular bruit on the head; 3) hyperpulsatile neck vessels, sometimes with small peripheral pulses.