Key result
AV fistula closure resolves high-output heart failure and lowers right atrial pressure by ~15 mm Hg.
Why the study?
Pericardial disease is a rare complication following renal transplantation.
Does closure of a patent arteriovenous fistula resolve high-output right heart failure and recurrent pericardial effusion mimicking effusive-constrictive pericarditis in a renal transplant recipient?
Case Report (n=1)
No
Does closure of a patent arteriovenous fistula resolve high-output right heart failure and recurrent pericardial effusion mimicking effusive-constrictive pericarditis in a renal transplant recipient?
In renal transplant patients presenting with recurrent pericardial effusion and constrictive hemodynamics, high-output heart failure from a patent hemodialysis arteriovenous fistula should be considered and treated with fistula closure to avoid unnecessary total pericardiectomy.
Answers are grounded in this paper and cite their sources.
Case supports considering arteriovenous fistula in post-transplant effusion differentials; leaves open whether closure obviates pericardiectomy.
Pericardial disease is a rare complication after renal transplantation. We present a patient who developed high-output cardiac failure from a large arteriovenous (AV) fistula with recurrent pericardial effusion resulting in a constrictive hemodynamic pattern that was revealed during cardiac catheterization. Pericardiectomy was considered for recurrent effusive pericarditis, but per cardiac surgery recommendations, closure of the AV fistula dramatically cured the patient's heart failure, and no recurrence of pericardial effusion was seen during follow-up almost a year later.
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Sanchez et al. (2022) conducted a case report in High-output right heart failure with recurrent pericardial effusion mimicking effusive-constrictive pericarditis after renal transplantation (n=1). Closure of patent left brachiocephalic arteriovenous (AV) fistula was evaluated on Resolution of heart failure symptoms, recurrent pericardial effusion, and constrictive hemodynamics. Closure of a patent arteriovenous fistula resolved high-output heart failure, normalized right atrial pressure from 21 to 6 mm Hg, and prevented pericardial effusion recurrence at 1 year.
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