Akademik Veri Yönetim Sistemi
17th BANTAO Congress, Antalya, Türkiye, 10 - 13 Kasım 2022, ss.26
Objective: Hyperdynamic heart failure is a rare but important complication of (Arteriovenous Fistula) AVF, which causes a typical heart failure clinic despite increased cardiac output while the left ventricular functions are normal. In this report, two cases who developed AVF-induced hyperdynamic heart failure after kidney transplantation and benefited clinically from its closure are presented.
CASE 1: A 55-year-old male, ESRD due to diabetic nephropathy, 9 years HD from brachio-radial AVF, kidney transplant from a cadaveric donor was performed in 2019. For three years, he had no clinical problems but for the past several months he had dyspnea, diffuse edema, and severe hypervolemia despite a well-functioning allograft. On physical examination, he was hypertensive (165/90mmHg), had bilateral lung rales and 3+ pretibial edema. He had acute coronary syndrome during his hospitalization, non-critical lesions were detected in his coronary angiography. While EF was 65% in his ECHO, PAP:65 mmHg was detected. Hyperdynamic heart failure secondary to AV fistula was considered. In Doppler, the neck section of the AV fistula was 7.9 mm, and the flow rate was 2500-3400 ml/min. AVF was closed in June 2022 and in less then two weeks his dyspnea and edema disappeared, and full clinical recovery was achieved.
CASE 2: A 68-year-old female had ESRD secondary to hypertension,she had radio-cephalic AVF for three years, kidney transplant was performed in November 2021, since then she had a well-functioning allograft. However in May 2022, dyspnea, orthopnea, and pretibial edema developed. While there was an increase in creatinine, there was no albuminuria/proteinuria. Cardiology did not consider systolic heart failure due to normal echocardiography (EF: 55%, PAP: 35 mmHg). Hyperdynamic heart failure was considered in the patient. AVF doppler; The diameter of the fistula boot was 8.3 mm and the flow rate was >2500 ml/min, and the AVF was closed. After fistula closure, dyspnea and orthopnea complaints regressed, and creatinine levels returned to basal levels.
Conclusion: High-output cardiac failure secondary to arteriovenous fistula is a condition with rapid clinical response to treatment, which should be considered in the case of clinical heart failure in kidney transplant patients. Ideally, in kidney transplant patients with well-functioning allografts, routine early closure of the AVF may be recommended.