title: Reversal of pulmonary hypertension after percutaneous closure of congenital renal arteriovenous fistula in a 74-year old woman.
abstract: We report the case of a large right renal arteriovenous fistula (AVF) in a 74-year old woman who presented with heart failure. Transthoracic echocardiography revealed normal left ventricular size and systolic function (ejection fraction 60-65%), moderately dilated right ventricle with severely depressed systolic function, and severe pulmonary hypertension. Right heart catheterization confirmed the elevated pulmonary pressures and showed a high cardiac output. Physical examination was remarkable for a right flank bruit. An abdominal ultrasound revealed an AVF originating from the distal right renal artery and dilated suprarenal inferior vena cava and hepatic veins. These findings were confirmed with an abdominal MRI. Percutaneous endovascular closure of the right renal AVF was successfully performed, with immediate reduction of pulmonary pressures and normalization of cardiac output. The patient's symptoms improved, and a post intervention echocardiogram revealed normalization of right ventricular size.
authors.affiliation: MedStar Cardiovascular Research Network and MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010.
authors.forename: Vijaywant
authors.initials: V
authors.lastname: Brar
authors.affiliation: MedStar Cardiovascular Research Network and MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010.
authors.forename: Nelson
authors.initials: N
authors.lastname: Bernardo
authors.affiliation: MedStar Cardiovascular Research Network and MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010.
authors.forename: William
authors.initials: W
authors.lastname: Suddath
authors.affiliation: MedStar Cardiovascular Research Network and MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010.
authors.forename: Gaby
authors.initials: G
authors.lastname: Weissman
authors.affiliation: MedStar Cardiovascular Research Network and MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010.
authors.forename: Federico
authors.initials: F
authors.lastname: Asch
authors.affiliation: MedStar Cardiovascular Research Network and MedStar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010. Electronic address: umberto.campia@medstar.net.
authors.forename: Umberto
authors.initials: U
authors.lastname: Campia
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arteriovenous fistula; Endovascular embolization; Pulmonary hypertension; Vascular plug