title: Serial cardiac influence of volume overload induced by interventional therapy for central venous stenosis or occlusion in chronic hemodialysis patients.
abstract: BACKGROUND
  Upper arm swelling and venous hypertension at arteriovenous fistula sites, and insufficiency of hemodialysis are induced by central venous lesions in chronic hemodialysis patients. Percutaneous transluminal angioplasty (PTA) for central venous lesions is first-choice treatment. Cardiac function can be evaluated by measuring the acute increase in venous return volume after PTA.
  
  
  METHODS
  We studied 6 cases of successful PTA for central venous stenotic or occluded lesions, and evaluated cardiac function by Swan-Ganz (SG) catheter and ultrasound echocardiography (UCG) at pre-, post-PTA, and on the following day.
  
  
  RESULTS
  Ejection fraction (EF) in 6 cases was 71.0 ± 5.5% on UCG. Two cases of subclavian venous stenosis, one case of subclavian venous occlusion, and three cases of brachiocephalic venous occlusion were enrolled. The reference diameter (RD) was 10.2 ± 4.9 mm, % diameter-stenosis (%DS) was 92.2 ± 12.2% at pre-PTA, and %DS at post-PTA was 21.7 ± 20.7%. There were no significant differences in pulmonary capillary-wedge, pulmonary artery, and right ventricular end-diastolic pressure in SG at pre- and post-PTA. The pressure of right atrium (RA) and cardiac output (CO) were significantly increased by PTA (RA pressure at pre-/post-PTA, 9.7 ± 2.9/11.7 ± 3.6 mmHg, p<0.05, CO at pre-/post-PTA 5.09 ± 2.07/5.45 ± 2.25 l/min, p<0.05). There were no significant differences in serial EF, left atrial and left ventricular diameters on UCG. However, the short-diameter of right ventricle (RV) and RA were significantly increased at post-PTA and recovered on the following day (RV short-diameter at pre-/post-/following-day PTA, 26.7 ± 3.5/32.5 ± 1.9/29.1 ± 1.7 mm, p<0.05; RA short-diameter at pre-/post-/following-day PTA, 30.2 ± 4.2/36.3 ± 2.4/32.1 ± 3.6mm, p<0.05).
  
  
  CONCLUSIONS
  Volume overload after PTA for central venous stenotic or occluded lesions in chronic hemodialysis patients resulted in increased RA and RV diameters. These changes were transient and completely recovered by the following day. PTA for central venous lesions in patients with normal EF can be performed without clinical cardiac problems.
authors.affiliation: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan. yhorita@kanazawa-heart.or.jp
authors.forename: Yuki
authors.initials: Y
authors.lastname: Horita
authors.forename: Masanobu
authors.initials: M
authors.lastname: Namura
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Taketsugu
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Terai
authors.forename: Ryota
authors.initials: R
authors.lastname: Fukuoka
authors.forename: Naoto
authors.initials: N
authors.lastname: Tama
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Takagi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kumatani
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishimori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D016121:Brachiocephalic Veins; D002407:Catheterization, Swan-Ganz; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000502:physiology*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006333:Heart Failure / Q000209:etiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006940:Hyperemia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013318:Stroke Volume; D013350:Subclavian Vein