Effect of closure of the arteriovenous fistula on left ventricular dimensions in renal transplant patients

Abstract

IntroductionBackground.Left ventricular hypertrophy is common in renal transplant patients.One of the factors that Left ventricular hypertrophy (LVH ) is very common might contribute to this phenomenon is the persisting in patients with end-stage renal failure.This is especipresence of an arteriovenous (AV ) fistula.Several ally important in view of the relationship between reports have described the presence of high-output LVH and mortality in these patients.The cause of cardiac failure, which subsided after closure of the AV LVH in renal patients is multifactorial and includes fistula.However, the long-term effects of elective closfactors such as hypertension, anaemia, the uraemic ure of the AV fistula on left ventricular dimensions state itself, and the presence of an arteriovenous fistula in stable renal transplant patients have never been (AV ) [1].It has been shown that left ventricular prospectively studied.dimensions may improve after renal transplantation, Subjects and methods.Twenty patients (15 male, 5 although complete regression of LVH is usually not female; mean age 5112 years) with a well-functioning obtained [2][3][4].One of the factors that may contribute renal transplant were included.Patients with severe to the persistence of LVH after renal transplantation heart failure (NYHA III or IV ) were excluded.Before is the presence of an AV fistula.The presence of an and 3-4 months after closure of the AV fistula, an AV fistula lowers systemic vascular resistance, resulting echocardiogram was performed.Fistula flow was in an increase in stroke volume and cardiac output in assessed by colour duplex-Doppler sonography.order to maintain blood pressure [5].In the end, this Results.Mean fistula flow was 1790648 ml/min.may lead to left ventricular volume overload and After closure of the fistula, left ventricular end-diastolic eccentric LVH.Various case reports have described diameter (LVEDD) (51.55.8 vs 49.35.4mm, high-output cardiac failure in patients with high-flow P<0.01) and left ventricular mass index (LVMi) fistulae, which subsided after closure of the fistula (135.034.1 vs 119.823.2) decreased.The change in [6,7].However, the cardiac effects of closure of AV LVMi after fistula closing was significantly related to fistulae in patients without clinical heart failure have the LVMi and LVEDD before operation (r=0.74 until now not been studied systematically.In this study and r=0.60,P<0.01), but not to fistula flow.we prospectively assessed the effect of closure of an Interventricular septal and posterior-wall diastolic AV fistula on left ventricular dimensions in stable renal thickness did not change.Heart rate decreased (7210 transplant patients.vs 699, P=0.03) Blood pressure and creatinine clearance did not change. Conclusion.Closure of the arteriovenous fistula in Subjects and methods stable renal transplant patients results in a decrease in LVMi, due to a reduction in LVEDD.The change Patients in LVMi is significantly related to the LVMi and LVEDD before fistula closing.In patients with a well-After giving informed consent, 20 patients with a functioning functioning allograft and persistent LV dilatation, kidney transplant with stable renal function were included.closure of the AV fistula might be considered.Seventeen patients had a Cimino fistula, two patients a brachial fistula, and one patient a PTFE graft.Patient characteristics are summarized in Table 1.Patients with heart failure NYHA III or IV were excluded, because in these patients the progression of the cardiac disease might complicate the interpretation of the effect of fistula closing.