High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old

Abstract

Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved. Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics.

Intraoperative Diagnosis of Bilateral Upper Limb Arteriovenous Fistulae in a Child: A Case Report

“…These symptoms or signs may also vary due to the time elapsed between the inciting event and the clinical presentation. 3,4,9 In our patient, the iatrogenic etiology of the fistulae probably stems from the history of multiple attempts at venous cannulation in both the antecubital fossae. Use of Doppler ultrasonography for making the initial diagnosis of arteriovenous fistulae, confirmation with CT angiography, management with surgical closure, and endovascular procedures or stenting of these lesions are described elsewhere in the literature.…”

“…Fistulae in the upper and lower extremities in children secondary to multiple attempts to establish vascular access, or due to trauma, have been reported in the literature. [2][3][4][5][6][7][8][9] To the best of our knowledge, this is the first report of bilateral upper extremity arteriovenous fistulae incidentally diagnosed in a child during surgery. We detected these arteriovenous fistulae after induction of general anesthesia.…”

“…3,10 Growing evidence, mainly in the form of case reports and small case series, describe iatrogenic pediatric arteriovenous fistulae of the lower extremities. 2–6 Only a few reports describe upper extremity arteriovenous fistulae in children, formed after multiple attempts at venipuncture, for hemodialysis, and due to trauma after a projectile injury. 8–11…”

“…These symptoms or signs may also vary due to the time elapsed between the inciting event and the clinical presentation. 3,4,9…”

Correção cirúrgica de fístula carotídeo-jugular traumática

“…[12][13][14] A machinery (or locomotive) murmur is pathognomonic for AVF 15 and the Nicoladoni-Branham sign, comprising bradycardia and increased mean blood pressure in response to manual compression of the fistula, can be observed in some cases. [16][17][18] Immediate surgical intervention is indicated in cases with evident vascular injury and hemodynamic instability. 8 Elective treatments should be preceded by careful therapeutic planning, including anatomic assessment of the structures involved.…”