197 ECHOCARDIOGRAPHIC FINDINGS IN CEREBRAL ARTERIOVENOUS MALFORMATIONS (AVM)

Abstract

Five newborns (mean weight 3.5 Kg) with cerebral AVM were evaluated by M-mode echocardiography (E). Two died without surgery, 1 intraoperatively, and 1 ten months post-operatively (PO). The fifth is alive 2 years PO with severe neurological damage. Initial E revealed mild right ventricular (RV) dilatation with an end diastolic dimension (EDD) of 1.9±.96cm. and normal septal motion. A normal left ventricular (LV) EDD of 1.98±.32 and an end diastolic volume index (EDVI) of 41.6±19.6 increased subsequently to 2.29±.26 and 59.2±2.31 on the 3 patients (pts.) examined just prior to surgery at 20-60 days of age. PO the 2 survivors had a markedly diminished LV EDVI of 24.7±6.2 and the RV diameter was .413±.21. Thus these pts. had E evidence of biventricular volume overload pre-operatively compared with PO, however, the pre-operative LV size was still in the normal range for normal infants. All but 1 pt. had an easily seen, large descending aorta on E. In utero most of the AVM return would be shunted via the ductus away from the LV and down the descending aorta. Thus the LV would be relatively small and unprepared for the massive increase in flow associated with the ex-utero circulation and the descending aorta would be large. Our E findings are consistent with this explanation. The relatively undilated LV at birth would be partly responsible for the inability of these infants to tolerate the acute volume overload and their early severe congestive heart failure.

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