SHM Converge Scientific Abstract ePoster Gallery-New Onset High-Output Heart Failure Post Renal Transplant

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This case describes a 60-year-old man who developed new-onset high-output heart failure after a renal transplant. He presented with dyspnea, worsening edema, and 20 pounds of weight gain. Exam showed a palpable thrill over a right upper extremity arteriovenous fistula (AVF), and testing revealed mild renal dysfunction, elevated BNP, chest X-ray congestion, and echocardiographic evidence of pulmonary hypertension with preserved left ventricular function.<br /><br />Despite escalating diuretic therapy, his symptoms and kidney function did not improve significantly. Because of the persistent volume overload and the presence of the AVF, vascular ultrasound was performed and showed very high fistula flow, suggesting a high-output access. Ventilation-perfusion imaging was inconclusive for chronic thromboembolic pulmonary hypertension, so right heart catheterization was done to clarify the cause. It demonstrated markedly elevated cardiac output (Fick CO 13.1 L/min, CI 7.0 L/min/m²) with low pulmonary vascular resistance, supporting high-output heart failure rather than primary pulmonary vascular disease. Shunt study findings also supported mixing from the fistula.<br /><br />The patient then underwent surgical excision of the AVF aneurysm and ligation of the fistula. After surgery, his dyspnea and edema improved, renal function recovered, and repeat echocardiography showed reduced right ventricular systolic pressure from 43 mm Hg to 23 mm Hg.<br /><br />The key message is that AVFs can be an overlooked but important cause of high-output heart failure and pulmonary hypertension, especially in patients with renal disease or after transplant. Right heart catheterization was essential for diagnosis, and fistula ligation provided both diagnostic confirmation and effective treatment.

Asset Subtitle

Waleed Ikram

Meta Tag

Author List Divya Shastri, Ibrahim Qaqish, Naomi Habib, Robert Lee, SAI-SRIDHAR Boddupalli, Saaed Nemr, Waleed Ikram

Category Clinical Vignettes

Concept Arteriovenous Fistula

Concept High-Output Heart Failure

Concept Fistula Ligation

Concept Right Heart Catheterization

Concept High-Flow Arteriovenous Fistula

Distinguished Non-Finalist

Presenter Organization Creighton University - Phoenix

Presenting Author Waleed Ikram

Track Adult

Keywords

high-output heart failure

renal transplant

arteriovenous fistula

pulmonary hypertension

right heart catheterization

volume overload

elevated cardiac output

fistula ligation

dyspnea

renal dysfunction

Arteriovenous Fistula

High-Output Heart Failure

Fistula Ligation

Right Heart Catheterization

High-Flow Arteriovenous Fistula