Remission of High-Output Heart Failure after Surgical Repair of 30-Month Arteriovenous Femoral Fistula: Case Report
We present a 15-year-old male patient who was admitted to our hospital because of breathlessness and palpitations at minimal physical effort (New York Heart Association class II). The patient had a history of an abdominal and left thigh firearm wound that was surgically treated 30 months earlier. Auscultation over the left femoral groin region revealed a systolo-diastolic murmur. X-ray examination of the chest demonstrated significant cardiomegaly. Transthoracic echocardiography revealed an enlargement of 4 cardiac chambers, as well as significant mitral and tricuspid regurgitation. Vascular ultrasound of the femoral artery and vein confirmed the diagnosis of a traumatic arteriovenous fistula. The patient underwent surgical correction of the fistula, after which the symptoms subsided rapidly. Follow-up echocardio-graphy performed 2 months after surgical repair showed a substantial reduction of cardiac size and a nearly complete absence of valvular regurgitations. This case highlights the importance of the recognition of arteriovenous fistulas as a cause of unexpected heart failure and demonstrates that the condition may improve substantially and rapidly after fistula correction.
Abreo G, Lenihan DJ, Nguyen P, Runge MS. 2000. High-output heart failure resulting from a remote traumatic aorto-caval fistula: diagnosis by echocardiography. Clin Cardiol 23:304-6.nDorney ER. 1957. Peripheral AV fistula of fifty-seven years duration with refractory heart failure. Am Heart J 54:778.nDurakoglugil ME, Kaya MG, Boyaci B, Cengel A. 2003. High output heart failure 8 months after an acquired arteriovenous fistula. Jpn Heart J 44(5):805-9.nFlaim SF, Mintees WJ, Nellis SH, Clark DP. 1979. Chronic arteriove nous shunt: evaluation of a model for heart failure in the rat. Am J Phys iol 236:H398.nFrishman W, Epstein AM, Kulick S, Killip T. 1974. Heart failure 63 years after traumatic arteriovenous fistula. Am J Cardiol 34:733-6.nHirai S, Hamanaka Y, Mitsui N, Kumagai H, Nakamae N. 2001. High-output heart failure caused by a huge renal arteriovenous fistula after nephrectomy: report of a case. Surg Today 31:468-70.nIngram CW, Satler LF, Rackley CE. 1987. Progressive heart failure secondary to a high output state. Chest 92:1117-8.nKhoury G, Stein R, Nabbout G, Jabbour-Khoury S, Fahl M. 1994. Traumatic arteriovenous fistula: "the Lebanese war experience". Eur J Vasc Surg 8:171-3.nPereira H, Cotrim I, Abreu A, et al. 1995. Heart failure due to a post-laminectomy arteriovenous fistula. Rev Port Cardiol 14:579-8.nPortela A, Bastos R, Pessoa B, Duarte R, Medeiros M, Paiva J. 2001. Remission of heart failure through endoluminal repair of femoral arteriovenous fistula with the use of a covered stent. Arq Bras Cardiol 76(3):242-4.nStellbrink C, Kunze KP, Lambertz H, Urhahn R, Hanrath P. 1991. An iatrogenic arteriovenous fistula following laminectomy. A rare differential diagnosis of heart failure [in German]. Dtsch Med Wochenschr 116:1141-3.n