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

[Le traitement périopératoire d'une défaillance biventriculaire suivant la fermeture d'une ancienne fistule artério-veineuse massive.]

From the Department of Anesthesiology and Reanimatology, Gunma University School of Medicine, Maebashi, Japan.

Address correspondence to: Dr. Takeshi Nara, Department of Anesthesiology, Gunma University School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma 371-8511, Japan. Phone: 027-220-8454; Fax: 027-220-8473; E-mail: narat{at}med.gunma-u.ac.jp

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 E₁ 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 E₁, 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.

This article has been cited by other articles:

				S. Bhatia, J. F. Morrison, T. C. Bower, and M. D. McGoon Pulmonary Hypertension in the Setting of Acquired Systemic Arteriovenous Fistulas Mayo Clin. Proc., July 1, 2003; 78(7): 908 - 912. [Abstract] [PDF]