Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula

Abstract

Purpose: To report the perioperative management of arteriovenous fistula (AVF) closure in a patient with high-output heart failure and pulmonary hypertension.Clinical features: In a 71-yr-old man, closure of a long-standing massive AVF between the right femoral artery and vein was performed. After closure of the AVF, his pulmonary artery pressure (PAP) increased from 52/21 mmHg to 68/26 mmHg, his cardiac index decreased from 5.27 L·min -1 ·m -2 to 3.18 L·min -1 ·m -2 , and his pulmonary wedge pressure increased from 15 mmHg to 32 mmHg due to an acute increase in afterload. Co-administration of prostaglandin E 1 and a phosphodiesterase III inhibitor improved the cardiac index and the PAP.Conclusions: Surgical closure of the fistula may not always lead to resolution of the high output cardiac failure. In this case, afterload management using arterial dilators (prostaglandin E 1 , phosphodiesterase III inhibitor), use of inotropic drugs (phosphodiesterase III inhibitor), and close attention to volume status was crucial for a successful outcome after surgical AVF closure.

Successful treatment of a renal arteriovenous fistula with pulmonary hypertension occurring 38 years after nephrectomy

“…Concern exists regarding perioperative management of hemodynamic changes during closure of fistula as the sudden increase in LV afterload can lead to acute cardiac decompensation. Contrary to a case developing biventricular failure after closure of a long-standing large AVF ( 6 ), there are publications showing rapid reversibility of heart failure with closure of AVF ( 7 ). In our case, despite a long medical history, closure of AVF did not lead to periprocedural decompensation.…”

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

“…Most of these lesions, however, need to be repaired. There have been cases wherein prolonged exposure to such a high output state predisposes the patient to even worse pulmonary artery hypertension after repair [ 13 ]. This underscores the need for urgent intervention in this lesion.…”

False aneurysm of perforating branch of the deep femoral artery—Report of two cases

“…Post-traumatic fistulas should be surgically repaired as soon as possible [38] . In the early stages, surgery is easier because there is no scar tissue or collateral circulation to complicate the dissection, and the anatomy is not distorted [39] .…”