Multiple Successful Angioembolizations for Refractory Cardiac Failure in a Preterm with Rapidly Involuting Congenital Hemangioma

Abstract

Rapidly involuting congenital hemangiomas (RICH) are the commonest variety of congenital hemangioma, often diagnosed antenatally as high-flow arteriovenous shunts causing hemodynamic compromise to the fetus. The postnatal management of such patients is often challenging. We present the case of an infant boy who was delivered prematurely at 29 weeks of gestation due to fetal compromise by a RICH, with features of high-output cardiac failure and major systemic hemodynamic steal from peripheral organs. Two early angioembolizations were required to manage his high-output cardiac failure. To our knowledge, this infant is the smallest and earliest newborn case of successful angioembolization for a complex, life-threatening vascular anomaly. We discuss the interventional dilemmas regarding the optimal timing of delivery and early embolization.

Keywords

RICH - high-output cardiac failure - angioembolization - preterm

Contributors' Statements

Dr. Sur was the clinical fellow involved in clinical management and care of the infant. He drafted the initial article, reviewed medical records, and finalized the final formatting of the revised script.

Dr. Manraj was the involved interventional radiologist who performed the embolizations. He drafted the interventional radiology aspects and provided the radiological images.

Dr. Lim was the primary obstetrician and helped drafting the management details and discussion of the antenatal complications.

Dr. Courtemanche was the plastic surgeon who was involved in the cosmetic aspect of the lesion and was involved in follow-up assessment of the infant.

Dr. Brooks was the primary cardiologist involved in consultation and guiding the management.

Dr. Lavoie and Dr. Albersheim were the primary neonatologists actively involved in the care of the infant and reviewed, revised, and approved the final article as submitted.

Dr. Albersheim is the corresponding author.

All authors approved the final article and agree to be accountable for all aspects of the work.

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