title: [Chronic right heart failure after implantation of a cava filter].
abstract: METHODS
  A 39-year-old woman complained of dyspnoea and increasing abdominal pressure sensation. A Greenfield filter had been implanted into her inferior vena cava (IVC) 4 years previously because of pulmonary embolism from a deep vein thrombosis after a hysterectomy with abscess formation. Physical examination revealed neck vein congestion, jaundiced sclerae, a tense abdominal wall, ascites and a soft machinery murmur in the paraumbilical region.
  
  
  METHODS
  Transaminase activities were slightly raised (GOT 38 U/I, GPT 20 U/I), but total bilirubin and direct bilirubin were markedly elevated (2.9 mg/dl and 1.1 mg/dl, respectively). There was no evidence of cholestasis or decreased liver synthesis. Ultrasound showed marked dilatation of the IVC and hepatic veins, and echocardiography revealed right ventricular enlargement with grade II tricuspid regurgitation. Calculated pulmonary arterial systolic pressure averaged 50 mmHG. Colour-coded Doppler sonography demonstrated an aorto-caval shunt at the level of the filter in the IVC and penetration of a filter strut into the aortic lumen.
  
  
  METHODS
  After removing the ascitic fluid by fluid and sodium restriction, and administration of an aldosterone antagonist and a loop diuretic, the A-V fistula was closed surgically and the filter removed. Three months after operation she was put on phenprocoumon (Quick value 20-30%). At the latest outpatient examination, 6 months after the operation, she was free of symptoms.
  
  
  CONCLUSIONS
  As filter implantation in the IVC may produce severe complications, indications for it need to be demonstrated by further studies of its efficacy.
authors.affiliation: Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhauses Essen.
authors.forename: U
authors.initials: U
authors.lastname: Jörger
authors.forename: D
authors.initials: D
authors.lastname: Albrecht
authors.forename: R
authors.initials: R
authors.lastname: Ritter
authors.forename: B
authors.initials: B
authors.lastname: Breuling
authors.forename: U J
authors.initials: UJ
authors.lastname: Winter
authors.forename: G V
authors.initials: GV
authors.lastname: Sabin
authors.forename: W
authors.initials: W
authors.lastname: Sandmann
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D010644:Phenprocoumon / Q000627:therapeutic use; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D016306:Vena Cava Filters / Q000009:adverse effects*; D014682:Vena Cava, Inferior
chemical_list: D000925:Anticoagulants; D010644:Phenprocoumon