Cardiac Disease Secondary to Postnephrectomy Arteriovenous Fistula

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THE detection of peripheral arteriovenous fistulas should be early, and regardless of cause they should be repaired surgically although they rarely alter the hemodynamics of the central circulation. The diagnosis of this type of peripheral vascular defect usually is not difficult to establish, particularly when the symptoms and abnormal physical findings are localized to an extremity or to superficial areas in other parts of the body. A communication between a renal artery and a renal vein may not be so simple to identify.

Irrespective of the cause, a renal arteriovenous fistula may be present for many years before abnormal cardiac hemodynamic effects are produced or become clinically recognizable. On the other hand, cardiomegaly, congestive heart failure, or a cardiac arrhythmia may develop early if the extracardiac shunt is large. Symptoms and abnormal objective findings referable to the heart may also be attributed to primary cardiac disease, and may go unrecognized as a reversible and so-called “curable” type secondary to another correctible vascular lesion.

A case of a postnephrectomy arteriovenous fistula 17 years after nephrectomy is being reported to present briefly the clinical manifestations and hemodynamics and to emphasize the importance of a complete physical examination as a reliable diagnostic approach in the detection of the extracardiac shunt that should be recognized as an unusual but possible cause of heart disease. One unreported case of a postnephrectomy arteriovenous fistula without secondary cardiac effects has been seen at the Cleveland Clinic.

Scheifley, Daugherty, Greene, and Priestley1 recently reviewed the literature on 12 . . .



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