Congestive Cardiac Failure and Intracranial Arteriovenous Communications in Infants and Children

Summary: Fourteen infants and children with intracranial arteriovenous fistulae are presented. They were seen by the Cardiology department at the Hospital for Sick Children over an eighteen year period from 1954 to 1972. Two separate groups were distinguished. Older infants and children tended to present with neurological problems. Hydrocephalus and seizures were common. Heart murmurs and abnormal electrocardiograms were still frequent in this group. Cardiac failure did not occur. These children had a wide variety of arteriovenous malformations. In contrast, the group of infants presenting in the first week of life had severe cardiac failure without exception. All died despite attempted surgical palliation of the fistula in two cases. Neurological signs were present in some but were over‐shadowed by the severe cardiac failure. Cyanosis or a history of cyanosis at some stage was present. Cyanosis may be due to several different mechanisms. Twelve of the fourteen children had continuous cranial murmurs. However, only in one case was the diagnosis suspected clinically. The murmurs were usually detected after the diagnosis had been made at catheterization and angiography. Auscultation of one‐hundred unselected neonatal heads by us, has shown that the presence of a murmur is rare. The importance of listening for cranial bruits in the newborn child with cardiac failure is re‐emphasized.