Circulation in neonates with intracranial arteriovenous fistula and cardiac failure.

Two newborn infants with severe cardiac failure caused by a large cerebral arteriovenous communication were studied with complete cardiac catheterization, indicator-dilution curves and angiography. In one infant, studied at age 10 hours, a large right to left shunt through the patent ductus was seen with retrograde aortic flow into the left carotid artery. The entire flow in the descending aorta was supplied from the ductus. The second infant, studied at age 5 days, had a 20 percent right to left shunt through the foramen ovale and the ductus was closed. Hypoxia was caused by inadequate oxygenation of pulmonary venous blood, atrial right to left shunting and possibly ductal right to left shunting. The hemodynamic findings in cases of cerebral arteriovenous fistula would seem to depend on the patient's age at the time the studies are carried out and the severity of the lesion. Cardiac output was more than twice the normal value and blood flow through the arteriovenous fistula was probably greater than 4 liters/min per m2.