title: Exercise right heart catheterization for inferior vena cava obstruction: confirming the hemodynamic significance of an anatomic lesion.
abstract: Retroperitoneal fibrosis is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that surrounds and often encases abdominal structures. In this report we describe an unusual presentation of retroperitoneal fibrosis and inferior vena cava (IVC) obstruction that was unidentified by noninvasive testing and ultimately diagnosed using exercise right heart catheterization and venography. Exercise hemodynamic catheterization revealed a high pressure gradient across the IVC obstruction during exercise that resulted in reduced preload and inappropriately low cardiac output reserve. The patient ultimately underwent angioplasty and stenting of the obstruction resulting in resolution of his symptoms.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.forename: Haraldur
authors.initials: H
authors.lastname: Bjarnason
authors.forename: Robert L
authors.initials: RL
authors.lastname: Frye
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D002302:Cardiac Output; D003251:Constriction, Pathologic; D005080:Exercise Test; D006439:Hemodynamics; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010690:Phlebography; D011237:Predictive Value of Tests; D012185:Retroperitoneal Fibrosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D015607:Stents; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014690:Venous Pressure
keywords: diagnostic cardiac catheterization; hemodynamics; peripheral vascular disease