He T, He X, Yuan XM. High-output heart failure secondary to iatrogenic arteriovenous fistula: A case report. World J Cardiol 2025; 17(4): 104748 [DOI: 10.4330/wjc.v17.i4.104748]
Corresponding Author of This Article
Xin He, Chief Physician, Department of Cardiology, Liuyang People’s Hospital of Nanhua University, No. 452 West Daowu Road, Changsha 410300, Hunan Province, China. hexin1958@126.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Apr 26, 2025; 17(4): 104748 Published online Apr 26, 2025. doi: 10.4330/wjc.v17.i4.104748
High-output heart failure secondary to iatrogenic arteriovenous fistula: A case report
Ting He, Xin He, Xu-Ming Yuan
Ting He, Department of Cardiology, The People’s Hospital of Liuyang, Changsha 410300, Hunan Province, China
Xin He, Xu-Ming Yuan, Department of Cardiology, Liuyang People’s Hospital of Nanhua University, Changsha 410300, Hunan Province, China
Author contributions: He T, He X, and Yuan XM contributed to conception and coordination of the study; He X contributed to design of ethical issues; He T contributed to acquisition of data, writing—original draft; He T, He X, and Yuan XM contributed to writing—review & editing.
Supported by the Scientific Research Project of Hunan Provincial Health Commission, No. 202203012538.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: All authors have no potential conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin He, Chief Physician, Department of Cardiology, Liuyang People’s Hospital of Nanhua University, No. 452 West Daowu Road, Changsha 410300, Hunan Province, China. hexin1958@126.com
Received: December 31, 2024 Revised: March 14, 2025 Accepted: April 3, 2025 Published online: April 26, 2025 Processing time: 111 Days and 19.6 Hours
Abstract
BACKGROUND
Arteriovenous fistula is a rare cause of refractory heart failure, and corrective measures may lead to dramatic improvement; however, the long-term cardiac remodeling outcomes, particularly after delayed closure, remain unclear.
CASE SUMMARY
A 57-year-old man was admitted to the hospital with complaints of exertional dyspnea for more than 10 years. Physical examination revealed wet crackles in the lungs and a continuous machinery murmur in the left lower back and groin area. Asymmetric edema and varicose veins were observed in the lower limbs. Echocardiography revealed a dilated right ventricle with severe pulmonary hypertension. Computed tomography revealed a left common iliac arteriovenous fistula linked to prior lumbar disc surgery. Surgical repair resolved the symptoms, with echocardiography at 4 months showing a reduced right atrium (RA) and ventricular (RV) diameter and tricuspid regurgitation. However, during the 2-year follow-up, gradual RA and RV re-expansion (from 35 mm to 51 mm and from 26 mm to 46 mm, respectively) was observed, despite sustained clinical stability.
CONCLUSION
This case highlights that delayed arteriovenous fistula closure may result in incomplete right heart reverse remodeling, even after symptomatic relief. Potential mechanisms include persistent hemodynamic stress from subclinical residual shunting or functional impairment due to chronic volume overload. Early intervention before irreversible right heart damage is critical for optimal outcomes.
Core Tip: Heart failure secondary to an arteriovenous fistula is a rare clinical condition. Our study reveals that delayed surgical repair may lead to incomplete reverse remodeling of the right heart, emphasizing the importance of timely intervention.
