title: High Output Cardiac Failure Resolving after Repair of AV Fistula in a Six-Month-Old.
abstract: Background. Acquired AVF in pediatrics are commonly caused by iatrogenic means, including arterial or venous punctures. These fistulae can cause great hemodynamic stress on the heart as soon as they are created. Case. A six-month-old 25-week gestation infant was referred for respiratory distress. Initial exam revealed tachypnea, tachycardia, and hypertension. There was a bruit noted on her left arm. An ultrasound showed an arteriovenous fistula. Its location, however, precluded intervention because of the high risk for limb-loss. An echocardiogram showed evidence of pulmonary hypertension that was treated with sildenafil and furosemide. However, no improvement was seen. On temporary manual occlusion of the fistula, the patient was noted to have increased her blood pressure and decreased her heart rate, suggesting significant hemodynamic effect of the fistula. The fistula was subsequently ligated and the patient clinically and echocardiographically improved. Conclusion. A patient in high output cardiac failure or pulmonary artery hypertension, especially prematüre patients with preexisting lung disease, should be probed for history of multiple punctures, trauma, or surgery and should have prompt evaluation for AVF. If it can be diagnosed and repaired, most of the cases have been shown to decrease the stress on the heart and reverse the pathologic hemodynamics.
authors.affiliation: University of Miami Miller School of Medicine, Department of Radiology, Miami, FL 33136, USA.
authors.forename: Uygar
authors.initials: U
authors.lastname: Teomete
authors.affiliation: University of Miami Miller School of Medicine, Department of Pediatrics, Miami, FL 33136, USA.
authors.forename: Rubee Anne
authors.initials: RA
authors.lastname: Gugol
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Neville
authors.affiliation: University of Miami Miller School of Medicine, Department of Surgery, Ryder Trauma Center, Miami, FL 33136, USA.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Dandin
authors.affiliation: University of Miami Miller School of Medicine, Department of Pediatrics, Miami, FL 33136, USA.
authors.forename: Ming-Lon
authors.initials: ML
authors.lastname: Young