Treating a Newborn with a Rare Brain Vascular Malformation: A Story of Timing, Teamwork, and Hope

A few days into life, most newborns are learning to breathe, feed, and adapt to the world outside the womb. Occasionally, however, a baby is born with a hidden challenge—one that places enormous stress on their tiny heart from the very first days of life.

Recently, we treated a 12-day-old newborn who developed severe cardiac failure soon after birth. The underlying cause was a rare congenital condition known as Vein of Galen malformation (VGAM).

What is Vein of Galen Malformation?

Vein of Galen malformation is an abnormal connection between arteries and veins in the brain that develops before birth. Instead of blood flowing normally through the brain tissue, it is diverted directly into a large vein. This creates a high-flow shunt, forcing the heart to pump excessively hard.

In newborns, this often presents as:

• Rapid breathing

• Poor feeding

• Enlarged heart

• Heart failure within days of birth

The choroidal type of VGAM, which this baby had, is particularly aggressive and commonly presents in the neonatal period.

Why the Heart Fails in a Brain Condition

Although the problem is in the brain, the heart suffers the most. The abnormal blood flow acts like a permanent “short circuit,” pulling large volumes of blood toward the brain vessels. The newborn heart, which is still adapting after birth, may not be able to cope with this extra load, leading to high-output cardiac failure.

This is why early recognition and referral to a specialized center is critical.

The Treatment: Gentle, Staged Neurointervention

The treatment of VGAM has been transformed by endovascular neurointervention. Using tiny catheters passed through blood vessels—without open surgery—we can selectively block abnormal connections.

In this baby:

• We performed a first session of embolization, carefully reducing the abnormal blood flow

• The goal was not to completely close the malformation in one sitting

• The priority was to stabilize the heart and control heart failure

Following the procedure, the most important outcome was achieved:
the cardiac failure came under control.

Why Treatment Is Done in Stages

In newborns, especially with choroidal VGAM, treatment must be gradual and carefully planned. Closing everything at once can be dangerous and may lead to brain injury due to sudden changes in blood pressure and venous drainage.

Staged treatment allows:

• The heart to recover and remodel

• Pulmonary pressures to improve

• The brain’s venous system to adapt safely

Further embolization sessions are usually planned weeks later, once the baby is stronger and more stable.

What Happens Next?

After the first successful procedure, the baby is closely monitored with:

• Echocardiography to assess heart function

• Clinical monitoring of feeding, breathing, and growth

• Brain imaging to watch for venous congestion or hydrocephalus

As the child grows, additional embolization sessions can be performed, with the aim of near-complete treatment later in infancy when it is safer to do so.

A Message for Parents and the Public

Conditions like Vein of Galen malformation are rare, but they are treatable. Early symptoms such as breathing difficulty, poor feeding, or unexplained heart failure in a newborn should never be ignored.

With:

• Early diagnosis

• Multidisciplinary care

• Advances in neurointervention

many babies with VGAM can survive and go on to have meaningful lives.

Closing Thoughts

This case is a reminder that modern medicine is not always about dramatic cures—it is often about judgment, patience, and timing. Treating the physiology first, respecting the fragility of a newborn, and allowing nature and medicine to work together can make all the difference.

Every such case reinforces why awareness matters—and why specialized care for newborns with complex conditions can truly be life-changing