An arteriovenous fistula from an aberrant right subclavian artery to the superior caval vein in a congenitally myxoedematous adult

A 52-year-old woman with congenital myxoedema presented with congestive heart failure and a continuous heart murmur. On cardiac catheterization, an aberrant right subclavian artery was found which supplied an arteriovenous malformation. Her heart failure, however, was secondary to concomitant severe aortic regurgitation which was clinically masked by the signs of the fistula. To our knowledge, a congenital arteriovenous malformation arising from an aberrant subclavian artery has not been reported in the adult.     

Congenital coronary arteriovenous fistula associated with dilated cardiomyopathy

A 59-year-old housewife with heart failure was found to have dilated cardiomyopathy associated with bilateral coronary artery fistula to the pulmonary artery. Coexistence of coronary arteriovenous fistula and dilated cardiomyopathy has not been reported and seems to be a casual association.     

Starfish-assisted off-pump obliteration of massive coronary arteriovenous fistulae

Coronary arteriovenous fistula is a rare congenital heart disease. A 71-year-old woman suffered from heart failure due to massive coronary arteriovenous fistulae from the right coronary artery and left circumflex artery to the coronary sinus. Using the off-pump technique, we successfully performed Starfish-assisted obliteration of the fistulae. Intraoperative transesophageal echocardiography was used to confirm the complete elimination of the abnormal shunt flow.     

Echocardiographic findings in right coronary arterial-right ventricular fistula: Report of a neonate with fatal congestive heart failure

Coronary arteriovenous fistula is a rare cause of congestive heart failure in the newborn. We describe a 2 day old infant with a large fistula between the right coronary artery and right ventricle that caused fatal congestive heart failure. An echocardiographic study revealed a large right ventricle, paradoxical motion of the interventricular septum and an enlarged aorta, suggesting an unusual location of a left to right shunt. The diagnosis was established at cardiac catheterization when a large left to right shunt was found at the ventricular level; the fistula was visualized by angiography.     

Iliac arteriovenous fistula complicating lumbar laminectomy

An iliac arteriovenous fistula may rarely complicate lumbar laminectomy, particularly at the L4-L5 level. We present such a complication in a 45-year-old man who presented in our institution with a postlaminectomy iliac arteriovenous fistula and severe congestive heart failure. Repair of the fistulous orifice and tubular reconstruction of the iliac artery were successfully performed.     

Congestive heart failure and continuous murmur in patient after lumbar disc surgery--a case report

We present a case of a 61-year-old female who was admitted to the hospital with symptoms of congestive heart failure. Diagnosis of arteriovenous fistula was suggested by the echocardiographic signs of high-output state and a continuous murmur heard especially close to the surgical scar from an intervention on the L4-L5 disc that the patient had undergone eight months before. Aortography confirmed arteriovenous fistula between the right common iliac artery and inferior vena cava. After surgical closure of the fistula, normal cardiac function was restored.     

High-output heart failure caused by arteriovenous fistula long after nephrectomy

A 70-year-old Japanese woman was admitted to our hospital because of anasarca. At 32 years of age, she had undergone nephrectomy for renal tuberculosis. A continuous abdominal bruit was heard. The chest X-ray showed cardiomegaly and dilatation of the pulmonary artery. Abdominal three-dimensional computed tomography scanning clearly revealed an arteriovenous fistula. Cardiac catheterization disclosed cardiac output of 9.2 l/min and a step-up of oxygen saturation at the renal vein level of the inferior vena cava. Surgical closure of the fistula promptly decreased her cardiac output and improved the heart failure. This is a rare case of an arteriovenous fistula developing long after nephrectomy and causing high-output heart failure.     

Belastungsdyspnoe,Angina pectoris und lautes Schwirren über der rechten Leiste bei einem 82-Jährigen

We report on the case of an 82-year-old man who was suffering from chest pain and dyspnea. Acute cardiac ischemia could be excluded. Cardiac catheterization also revealed an aneurysm of the right common iliac artery. In addition, an arteriovenous fistula between the iliac artery and vein was detected by computer tomography angiography. Apparently, these symptoms were caused by a high output heart failure with known coronary heart disease. The patient was treated by implantation of prosthesis and oversewing the fistula which led to full recovery.     

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review

High-output heart failure caused by a tumor-related arteriovenous fistula in adults is a rare clinical condition. We herein report a case of high-output heart failure caused by an arteriovenous fistula associated with renal cell carcinoma and a literature review of 29 published cases to date. Renal cell carcinoma seems to be the most common underlying tumor. For the diagnosis, right heart catheterization and enhanced computed tomography (CT) are considered useful. The removal of the underlying tumor and arteriovenous fistula is the best treatment for heart failure.     

Pulmonary arterial hypertension and right heart failure—A late‐onset complication after cardiac catheterization

Arteriovenous fistula is a possible complication of diagnostic procedures requiring arterial femoral catheterization. Late onset manifestation is reported rarely. An impressive case of severe pulmonary arterial hypertension and consecutive right heart failure caused by an arteriovenous fistula between the common iliac artery and the distal inferior caval vein manifesting four years after cardiac catheterization in described. © 2009 Wiley‐Liss, Inc.     

The thrombosis of a 13 years old aneurysmal arteriovenous fistula

A 46 years old female, with chronic stage renal failure for 15 years, presents to the emergency room with a thrombosis of her brachiocephalic arteriovenous fistula (functional for 13 years). The cephalic vein was aneurismal (6 cm diameter) and the brachial artery was not dilated. After proximal and distal control of the brachial artery and the proximal cephalic vein, the aneurismal arteriovenous fistula was excise, the cephalic vein was ligatured, and the brachial artery was repaired with an end to end anastomosis.     

Successful intervention for high-output cardiac failure caused by massive renal arteriovenous fistula-a case report

Renal arteriovenous fistula is a rare clinical entity that may produce high-output cardiac failure. This report describes the case of an 81-year-old woman in whom recurrent episodes of congestive heart failure developed over a relatively short time. A massive renal arteriovenous fistula was visualized by CT scan and arteriography. Successful embolization was performed under hemodynamic monitoring with complete resolution of the patient's symptoms.     

Congestive heart failure due to traumatic arteriovenous fistula--two case reports

Arteriovenous fistulas are abnormal connections between the high-pressure and high-resistance arterial system and the venous system with opposite features. Due to its lower resistance, the blood preferentially flows via the fistula rather than through the capillary bed. The amount of shunt flow depends on its size and proximity to the heart. Due to the increase in circulating volume, progressive dilation develops in the whole vascular system proximal to the shunt. Cardiomegaly and venous distention may return to normal after surgical repair of this vascular abnormality. Two cases are presented of heart failure due to traumatic arteriovenous fistula, one of which was between the right renal artery and inferior vena cava and the other between the left renal artery and renal vein.     

Heart failure following lumbar surgery

High-output heart failure may be caused by an arteriovenous fistula. A case is reported of an arteriovenous fistula following discectomy.     

Coronary artery fistulas: clinical and therapeutic considerations

Coronary artery fistulas vary widely in their morphological appearance and presentation. These fistulas are congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel, or other structure, bypassing the myocardial capillary network. The majority of these fistulas arise from the right coronary artery and the left anterior descending coronary artery; the circumflex coronary artery is rarely involved. Clinical manifestations vary considerably and the long-term outcome is not fully known. The patients with coronary fistulas may present with dyspnea, congestive heart failure, angina, endocarditis, arrhythmias, or myocardial infarction. A continuous murmur is often present and is highly suggestive of a coronary artery fistula. Differential diagnosis includes persistent ductus arteriosus, pulmonary arteriovenous fistula, ruptured sinus of Valsalva aneurysm, aortopulmonary window, prolapse of the right aortic cusp with a supracristal ventricular septal defect, internal mammary artery to pulmonary artery fistula, and systemic arteriovenous fistula. Although noninvasive imaging may facilitate the diagnosis and identification of the origin and insertion of coronary artery fistulas, cardiac catheterization and coronary angiography is necessary for the precise delineation of coronary anatomy, for assessment of hemodynamics, and to show the presence of concomitant atherosclerosis and other structural anomalies. Treatment is advocated for symptomatic patients and for those asymptomatic patients who are at risk for future complications. Possible therapeutic options include surgical correction and transcatheter embolization. Historical perspectives, demographics, clinical presentations, diagnostic evaluation, and management of coronary artery fistula are elaborated.     

Normal left ventricular ejection fraction in systemic arteriovenous fistula. Implications for the use of noninvasive methods in differential diagnosis of heart failure

Heart failure is frequently a result of impaired systolic ventricular performance. We describe a patient with heart failure and a systemic arteriovenous fistula who had left ventricular enlargement and a normal left ventricular ejection fraction, demonstrated by gated cardiac blood pool scanning. The heart failure was relieved by surgical repair of the fistula, but the left ventricular ejection fraction did not change. These observations show that volume overload rather than impaired systolic function was the mechanism by which heart failure occurred in this patient with a systemic high output state and illustrate the value of gated cardiac blood scanning in noninvasively elucidating the mechanism of heart failure.     

Transcatheter embolization of hepatic arteriovenous fistula in Osler-Weber-Rendu disease--a case report

Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) is associated with arteriovenous fistulas throughout the body that can cause hemodynamic abnormalities. Owing to their size and extent, surgical repair is often not feasible. A patient referred for presumed valvular heart disease is described. On the basis of oximetry data at cardiac catheterization, a large intrahepatic arteriovenous fistula was discovered by aortography. This finding and a history of recurrent epistaxis were consistent with Osler-Weber-Rendu disease. Owing to the size of the fistula, embolization of the right hepatic artery with Gianturco coils was chosen as treatment, with resultant symptomatic improvement and decreased arteriovenous shunting.     

Spontaneous idiopathic subclavian arteriovenous fistula: a case report.

Systemic arteriovenous (AV) fistulas are a rare but correctable cause of hyperkinetic circulation and congestive heart failure. They are generally due to catheterization procedures, surgery, trauma, or aneurysms. A case of truly spontaneous AV fistula between left subclavian artery and left innominate vein is described. This patient presented with symptoms that might clinically be mistaken for a carpal tunnel syndrome. The discovery of a continuous to-and-fro murmur on her left upper sternal border led to the correct diagnosis. Surgical ligature of the fistula provided complete relief of the woman's symptoms.     

Endovascular repair of a traumatic popliteal arteriovenous fistula

We report a case of an arteriovenous fistula (AVF) following osteosynthetic treatment of a fracture of the lower limb 13 years ago. A stent-graft technique had been used to close a high flow traumatic AVF between the popliteal artery and the popliteal vein. The failure to properly evaluate traumatic AVF may sometimes lead to remarkable delay in diagnosis with devastating consequences including edema, ischaemia, ulceration and high output heart failure. Endovascular treatment of these lesions is promising but long-term follow-up will be required to determine the durable patency and the onset of potential complications.     

Doppler echocardiographic features of coronary arteriovenous fistula. Complementary roles of cross sectional echocardiography and the Doppler technique

The Doppler echocardiographic features of coronary arteriovenous fistula were investigated in eight patients with left or right coronary arteriovenous fistulas who had a continuous heart murmur in the upper precordial area and whose diagnoses were confirmed by coronary angiography. In four patients the dilated lumen of the coronary arteriovenous fistula was visualised by cross sectional echocardiography. Of these, three showed abnormal unidirectional continuous flow signals with broad velocity spectra in the fistula. Abnormal, powerful, unidirectional or bidirectional continuous Doppler signals were detected in part of the pulmonary artery in two of the eight patients, in part of the right ventricle in two, and in part of the right atrium in one; these signals were interpreted as indicating shunt flow. Although the opening of the fistula was difficult to visualise by cross sectional echocardiography, the pulsed Doppler technique helped identify the site in patients with dilatation of the coronary artery. In the remaining three patients with a small shunt no abnormal findings were obtained with cross sectional echocardiography or the Doppler technique. The size of the fistula below which no abnormal findings may be obtained by Doppler echocardiography still needs to be determined.