Neonatal Congestive Heart Failure Due to a Subclavian Artery to Subclavian Vein Fistula Diagnosed by Noninvasive Procedures

Tatum, Gregory H. MD
Newman, Beverley MD
Ralphe, J. Carter MD

^*Division of Cardiology, Children's Hospital of Pittsburgh, Pittsburgh, Pa, USA
^†Division of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, Pa, USA

Corresponding Author: J. Carter Ralphe, MD, Division of Pediatric Cardiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA. Tel: (+1) 412-692-6762; Fax: (+1) 412-692-5138; E-mail: [email protected]

Accepted in final form: February 7, 2006.

Congenital Heart Disease 1(3):p 120-123, May 2006.

Congestive heart failure in the neonate is usually due to intracardiac anomalies or cardiac dysfunction. Extracardiac causes are rare.

Patient

We report a newborn infant who presented with respiratory distress and cardiomegaly.

Result

Echocardiography identified a dilated right subclavian artery and vein and superior vena cava. Magnetic resonance imaging confirmed a subclavian artery to subclavian vein fistula that was treated with surgical ligation. The infant recovered fully. This case underscores the need for clinical suspicion of fistulous connection in unusual locations in the face of unexplained heart failure in the neonate.

Conclusion

Echocardiographic and magnetic resonance imaging are effective noninvasive modalities to confirm the diagnosis prior to surgical intervention.