title: Impact of a large hemodialysis arteriovenous fistula: on myocardial protection during cardiopulmonary bypass.
abstract: Arteriovenous fistulae have a substantial impact on systemic hemodynamics, but their effect on cardiopulmonary bypass is not well understood. The left-to-right shunting of blood through an arteriovenous fistula can create flow problems during cardiopulmonary bypass. We present the case of a 59-year-old man with end-stage renal disease who underwent coronary artery bypass grafting. During surgery, a large brachiocephalic arteriovenous fistula provided excessive venous return to the heart, compromising the myocardial protection offered by cardiopulmonary bypass. We modified the venous cannulation from a 2-stage single cannula to a bicaval cannula and were then able to achieve cardioplegic arrest and myocardial protection with no further problems.
authors.affiliation: Cardiovascular Surgery Clinic, Ataturk Education & Research Hospital, 06533 Ankara, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Cetin
authors.forename: Erol
authors.initials: E
authors.lastname: Sener
authors.forename: Aysegul
authors.initials: A
authors.lastname: Kunt
authors.forename: Mete
authors.initials: M
authors.lastname: Hidiroglu
authors.forename: Aslihan
authors.initials: A
authors.lastname: Kucuker
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003326:Coronary Circulation; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D016896:Treatment Outcome