Unusual arteriovenous communications: arteriographic and hemodynamic studies

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THE existence of hyperkinetic cardiovascular states due to abnormal arteriovenous communications has been well-documented, particularly in congenital heart disease with shunts and in traumatic and congenital arteriovenous fistulas of large vessels. Less information is available concerning hyperkinetic cardiovascular states associated with rare forms of arterio-venous communications, including those diseases characterized by innumerable small arteriovenous communications.

Abnormal arteriovenous communications are now more readily detected and amenable to treatment because of new or improved diagnostic and surgical technics. Moreover, with renewed interest in earlier and more precise diagnosis than was formerly possible, new information is becoming available concerning morphologic and physiologic changes.

This report concerns the clinical and hemodynamic findings in seven patients with various types of arteriovenous communications associated with evidence of hyperkinetic circulation, and highlights the importance of arteriographic and hemodynamic studies in evaluation of the lesions.

Materials and methods

Seven patients with clinical and laboratory evidence of arteriovenous communications were evaluated in the Cleveland Clinic Hospital. Hemodynamic studies were performed after treatment had been discontinued for one month. Catheters were inserted percutaneously through an antecubital vein and brachial artery, and were advanced centrally to the level of the superior vena cava or subclavian vein and axillary artery, respectively. Cardiac output was determined with indocyanine green dye and a Gilford densitometer as described previously.1, 2 Heart rate was measured from a continuously recording electrocardiograph, arterial pressure by a Statham P23Db transducer, and left ventricular ejection time from a rapid recording (100 mm per sec) of the arterial pressure tracing. The. . .



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