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CASE REPORT
Arteriovenous fistula and high output cardiac failure in a double lung transplant patient
  1. Joshua Bennitz1,
  2. Martin Simons2 and
  3. Gianni R Lorello3,4
  1. 1 Department of Anesthesiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
  2. 2 Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Joshua Bennitz, joshua.bennitz{at}vch.ca

Abstract

We present a case of a high cardiac output (CO) arteriovenous fistula (AVF) with pulmonary hypertension (PH) post-double lung transplant presenting for AVF occlusion. The patient presented with a CO of 9.83 L/min, pulmonary artery pressures of 64/16, inferior vena cava dilatation and an AVF between the left common iliac artery and vein. Given her anaesthetic considerations, we elected to proceed with local anaesthesia and sedation. Trial balloon occlusion resulted in an increase in blood pressure and a headache that resolved with balloon deflation. Successful final occlusion with an endovascular stent was completed without adverse events. PH is a complex pathophysiology with the potential for catastrophic decompensation. Anaesthesiologists must consider a patient’s comorbidities and the procedure to safely administer anaesthesia without complications.

  • anaesthesia
  • cardiovascular medicine
  • interventional radiology
  • pulmonary hypertension
  • transplantation
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Footnotes

  • Contributors JB: conception and design, acquisition, analysis and interpretation of data, drafting the article, final approval of the version published, agreement to be accountable for the article. MS: acquisition of data, critical appraisal and review of the article, final approval of the version published, agreement to be accountable for the article. GRL: conception and design, acquisition, analysis and interpretation of data, drafting the article, final approval of the version published, agreement to be accountable for the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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