Decompensated high-output congestive heart failure in a patient with AVF and the role of right heart catheterization: A case study

Kunal Malhotra, Vibhu Dhawan, Pranav Dalal, Venkatesh Ariyamuthu, Prasad Bichu, Joshua Botdorf, Ramesh Khanna

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high-output congestive heart failure. A right heart catheterization was done, which confirmed elevated right-sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan-Ganz catheter, improved from 37 to 30mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow-up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post-kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post-transplant patients.

Original languageEnglish (US)
JournalHemodialysis International
Volume16
Issue numberSUPPL. 1
DOIs
StatePublished - Oct 1 2012

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Cardiac Catheterization
Heart Failure
Pulmonary Hypertension
Arteriovenous Fistula
Transplants
Pressure
Fistula
High Cardiac Output
Kidney
Cough
Dyspnea
Pulmonary Artery
Signs and Symptoms
Ligation
Echocardiography
Renal Dialysis
Dialysis
Catheters
Survival

Keywords

  • Arteriovenous fistula
  • Fistula toxicity
  • Heart failure
  • Pulmonary hypertension
  • Right heart catheterization

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

Decompensated high-output congestive heart failure in a patient with AVF and the role of right heart catheterization : A case study. / Malhotra, Kunal; Dhawan, Vibhu; Dalal, Pranav; Ariyamuthu, Venkatesh; Bichu, Prasad; Botdorf, Joshua; Khanna, Ramesh.

In: Hemodialysis International, Vol. 16, No. SUPPL. 1, 01.10.2012.

Research output: Contribution to journalArticle

Malhotra, Kunal ; Dhawan, Vibhu ; Dalal, Pranav ; Ariyamuthu, Venkatesh ; Bichu, Prasad ; Botdorf, Joshua ; Khanna, Ramesh. / Decompensated high-output congestive heart failure in a patient with AVF and the role of right heart catheterization : A case study. In: Hemodialysis International. 2012 ; Vol. 16, No. SUPPL. 1.
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