title: Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access.
abstract: Patients with end-stage renal disease (ESRD) with arteriovenous dialysis access (AVDA) can develop symptoms of heart failure and pulmonary hypertension (PH). We report on 5 patients with ESRD and AVDA who presented with shortness of breath, heart failure, and PH. All patients had partial or complete closure of AVDA and were reevaluated after AVDA revision. All 5 subjects had clinical and echocardiographic evidence of heart failure, hypertensive heart disease, left ventricular diastolic dysfunction, and PH at baseline. After complete closure ([Formula: see text]) or partial banding ([Formula: see text]) of AVDA, mean New York Heart Association class improved from [Formula: see text] to [Formula: see text] ([Formula: see text]). Mean 6-minute walk distance improved from [Formula: see text] to [Formula: see text] m ([Formula: see text]). Serial echocardiography revealed a decrease in the right ventricle∶left ventricle ratio from [Formula: see text] to [Formula: see text] ([Formula: see text]) and improved diastolic dysfunction parameters. On right heart catheterization before definitive AVDA revision, acute manual fistula or graft occlusion led to an average decrease in cardiac output of 1.1 L/min with no other changes in hemodynamics: [Formula: see text] to [Formula: see text] L/min ([Formula: see text]). However, the average decrease in cardiac output after definitive revision of the AVDA (mean, 90 days) was 4.0 L/min with marked improvements in biventricular filling pressures and pulmonary artery pressure. In patients with ESRD and AVDA presenting with heart failure and PH, revision or closure of AVDA can markedly improve dyspnea as well as the clinical, echocardiographic, and hemodynamic manifestations of heart failure and PH.
authors.affiliation: Department of Medicine, Heart and Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Farhan
authors.initials: F
authors.lastname: Raza
authors.affiliation: Department of Medicine, Heart and Vascular Institute, Temple University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alkhouli
authors.affiliation: Department of Medicine, Heart and Vascular Institute, Pulmonary Hypertension and Right Heart Failure Program, Temple University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Frances
authors.initials: F
authors.lastname: Rogers
authors.affiliation: Department of Medicine, Heart and Vascular Center, Pulmonary Hypertension and Heart Failure-Cardiac Transplant Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Anjali
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: Department of Medicine, Heart and Vascular Institute, Pulmonary Hypertension and Right Heart Failure Program, Temple University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Forfia
keywords: arteriovenous dialysis access; fistula; fistula closure; high-output heart failure; pulmonary hypertension