Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula.
OBJECTIVE
To report the perioperative management of arteriovenous fistula (AVF) closure in a patient with high-output heart failure and pulmonary hypertension.


METHODS
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 E 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.
Nara
T
T
Department of Anesthesiology and Reanimatology, Gunma University School of Medicine, Maebashi, Japan. narat@med.gunma-u.ac.jp
Yoshikawa
D
D
Saito
S
S
Kadoi
Y
Y
Morita
T
T
Goto
F
F
D015105:3',5'-Cyclic-AMP Phosphodiesterases / Q000037:antagonists & inhibitors; D000368:Aged; D000527:Alprostadil / Q000627:therapeutic use; D001164:Arteriovenous Fistula / Q000601:surgery*; D016534:Cardiac Output, High / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017023:Coronary Angiography; D054684:Cyclic Nucleotide Phosphodiesterases, Type 3; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D014656:Vascular Surgical Procedures; D014665:Vasodilator Agents / Q000627:therapeutic use; D018754:Ventricular Dysfunction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
D010726:Phosphodiesterase Inhibitors; D014665:Vasodilator Agents; D015105:3',5'-Cyclic-AMP Phosphodiesterases; D054684:Cyclic Nucleotide Phosphodiesterases, Type 3; D000527:Alprostadil