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Arterijsko-venska fistula kot vzrok srčnega popuščanja = Arterio-venous fistula as a cause of congesive heart failure
Starc, Radovan ...
A case report of congestive heart failure due to arterio-venous fistula (A-V fistula) is presented and discussed in this article. 33-years old patient in NYHA II functional class was subjected to ...repeoted cardiac catheterization (femoral approach) due to a recurrent and significant mitral regurgitation. Surgical reconstruction of rheumatic mitral valve disease with significant mitral regurgitation was carried out one year ago. Femoral A-V fistula was clinically suspected and confirmed by color doppler investigation the day after cardiac catheterization. The patient was discharged, but had to be readmitted into the hospital one week later due to the symptoms and signs of predominantly left heart failure at rest (NYHA IV), while significant A-V fistula still persisted. Congestive heart failure at rest required treatment with diuretic and ACE inhibitor drugs. Heart failure at rest disappeared and treatment with drugs was discontinued two months atter A-V fistula had been closed surgically. The appearence of heart failure was attributed to the high-output volume overload of the heart (high-output failure) caused by femoral A-V fistula, while disappearence of heart failure was a direct consequence of the surgical closure of A-V fistula and interruption of an highoutput circulation. The clinical importance of this contribution is in reminding us on one of the neglecting and curable cause of high output circulation that can precipitate heart failure.
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