title: Acute systemic hypotension after arteriovenous fistula construction in a patient with severe aortic stenosis.
abstract: We report the case of a 53-year-old hemodialysis patient with severe aortic stenosis, who developed acute systemic hypoperfusion after arteriovenous fistula (AVF) construction. He presented with hypotension and repeated syncope soon after distal radiocephalic AVF construction, and finally developed a respiratory arrest. His blood pressure and hemodynamics recovered promptly by sub-emergent aortic valve replacement surgery. In the present case, the heart with severe aortic stenosis could not increase cardiac output in response to the reduction in peripheral vascular resistance caused by the AVF. High-output heart failure, a relatively rare AVF-associated disorder, occurs with an excessive AVF flow, usually more than 3 L/min or 30% of cardiac output. However, heart failure may develop soon after construction of an AVF with a moderate blood flow if a patient's cardiac function is severely impaired. In addition, heart failure may improve with AVF preservation if the underlying heart disease is treatable.
authors: Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, 1 Kanda-izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan. misenn@mitsuihosp.or.jp.
authors: Naobumi
authors: N
authors: Mise
authors: Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, 1 Kanda-izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors: Lisa
authors: L
authors: Uchida
authors: Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, 1 Kanda-izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors: Mototsugu
authors: M
authors: Tanaka
authors: Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, 1 Kanda-izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors: Shinji
authors: S
authors: Tanaka
authors: Division of Cardiology, Department of Medicine, Mitsui Memorial Hospital, Tokyo, Japan.
authors: Hiroyoshi
authors: H
authors: Nakajima
authors: Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital, 1 Kanda-izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
authors: Tokuichiro
authors: T
authors: Sugimoto
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002302:Cardiac Output; D006333:Heart Failure / Q000209:etiology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D014655:Vascular Resistance