Remission of High-Output Heart Failure after Surgical Repair of 30-Month Arteriovenous Femoral Fistula: Case Report

Abstract

We present a 15-year-old male patient who was admitted to our hospital because of breathlessness and palpitations at minimal physical effort (New York Heart Association class II). The patient had a history of an abdominal and left thigh firearm wound that was surgically treated 30 months earlier. Auscultation over the left femoral groin region revealed a systolo-diastolic murmur. X-ray examination of the chest demonstrated significant cardiomegaly. Transthoracic echocardiography revealed an enlargement of 4 cardiac chambers, as well as significant mitral and tricuspid regurgitation. Vascular ultrasound of the femoral artery and vein confirmed the diagnosis of a traumatic arteriovenous fistula. The patient underwent surgical correction of the fistula, after which the symptoms subsided rapidly. Follow-up echocardio-graphy performed 2 months after surgical repair showed a substantial reduction of cardiac size and a nearly complete absence of valvular regurgitations. This case highlights the importance of the recognition of arteriovenous fistulas as a cause of unexpected heart failure and demonstrates that the condition may improve substantially and rapidly after fistula correction.