Aim Vein of Galen malformation (VOGM) is a rare and complex congenital vascular anomaly involving the cerebral venous system with secondary consequences on the heart and the circulatory system due to abnormal blood flow patterns. This case study presents prenatal diagnosis, the clinical course, and the management of a neonate diagnosed with VOGM.

Material and Method Case report: We present a case of a newborn male child, delivered via cesarean section at 38 weeks gestational age following spontaneous conception. During the prenatal ultrasound examinations of the fetus, there was a suspicion of A-V malformation in the brain and evidence of hypertrophy on the right side of the heart.

Results Fetal echocardiographic findings confirmed cardiomegaly (cardiothoracic index [CTI] 0.65), myocardial hypertrophy, dilatation of the right heart chambers, and relatively significant tricuspid valve regurgitation (+2/4) with a max. peak velocity of 2 m/s. No intraventricular septal defects were identified, but both atrial chambers displayed wall hypertrophy (4–5 mm), with observed changes that correspond to signs of fetal heart failure. Also, a fetal MRI and postnatal MRI brain imaging revealed an aneurysmal malformation measuring approximately 6.2 cm in length and 2.9 cm in width with a broad drainage in the rectus sinus and sinus confluence.

Conclusions Endovascular embolization treatment was undertaken to occlude the abnormal arteriovenous connections with the aim of normalizing blood flow and reducing potential heart complications associated with VOGM. This case underscores the complexities inherent in managing VOGM in neonates. Timely diagnosis, a multidisciplinary approach, and minimally invasive endovascular procedures play a crucial role in the long-term prognosis.