Favourable outcome of a neonate with vein of Galen malformation with concurrent right superior vena cava draining into the left atrium

We present a neonate with a large vein of Galen malformation and an unusual drainage of the large vein returning blood from the upper half of the body into the right atrium (superior vena cava) into the left atrium. Remarkably, the infant showed no signs of cyanosis, heart failure, or pulmonary hypertension. We suggest this rare anomaly may have provided in-utero protection by offloading blood flow and reducing strain on the fetal heart and lungs.