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Background and objective <p>High-flow cerebral vascular malformations (HFCVM) are rare, life-threatening anomalies causing severe neonatal cardiorespiratory compromise. Targeted neonatal echocardiography (TNE) enables detailed hemodynamic assessment to guide stabilization and embolization timing. We evaluated a multidisciplinary, TNE-guided protocol to optimize individualized care and shorten shunting duration.</p> Methods <p>Single-center case series of five neonates with HFCVM admitted to a Level IV NICU (June 2022–June 2025). The protocol incorporated serial TNE for prenatal diagnosis, pre-/post-embolization care, and intra-procedural monitoring. TNE categorized cardiovascular phenotypes, guided embolization timing, and monitored cardiac function.</p> Results <p>Five neonates with HFCVM were managed using this protocol. Median number of embolizations per neonate were 2 (2.0–2.5). Four patients exhibited flow-mediated physiology with high cardiac output and ductal-dependent systemic perfusion. Four patients survived to discharge. One patient experienced a fatal intracranial hemorrhage.</p> Conclusion <p>A physiology-driven, TNE-guided approach for neonatal HFCVM is feasible and supports tailored hemodynamic management and staged embolization. Prospective multicenter validation is warranted.</p>

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Targeted neonatal echocardiography-guided management of high flow cerebral vascular malformations: Impact of a multidisciplinary neurohemodynamics team

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月20日

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  • NA Aleem,
  • AH Stanford,
  • SS Lee,
  • S. Ortega-Gutierrez,
  • PJ McNamara

摘要

Background and objective

High-flow cerebral vascular malformations (HFCVM) are rare, life-threatening anomalies causing severe neonatal cardiorespiratory compromise. Targeted neonatal echocardiography (TNE) enables detailed hemodynamic assessment to guide stabilization and embolization timing. We evaluated a multidisciplinary, TNE-guided protocol to optimize individualized care and shorten shunting duration.

Methods

Single-center case series of five neonates with HFCVM admitted to a Level IV NICU (June 2022–June 2025). The protocol incorporated serial TNE for prenatal diagnosis, pre-/post-embolization care, and intra-procedural monitoring. TNE categorized cardiovascular phenotypes, guided embolization timing, and monitored cardiac function.

Results

Five neonates with HFCVM were managed using this protocol. Median number of embolizations per neonate were 2 (2.0–2.5). Four patients exhibited flow-mediated physiology with high cardiac output and ductal-dependent systemic perfusion. Four patients survived to discharge. One patient experienced a fatal intracranial hemorrhage.

Conclusion

A physiology-driven, TNE-guided approach for neonatal HFCVM is feasible and supports tailored hemodynamic management and staged embolization. Prospective multicenter validation is warranted.