High-output heart failure secondary to large pelvic arteriovenous malformation.

摘要

A 64-year-old woman presented to our hospital with an 8-month history of exertional dyspnea and high-output congestive heart failure. On physical examination, the most striking features were a wide pulse pressure 120/40 mm Hg, increased jugular venous pressure and 2/6 systolic murmur at the left upper sternal border. Chest x-ray showed cardio-megaly. Echocardiography revealed normal ejection fraction, right ventricular dilatation and significant tricuspid regurgitation. Investigations were negative for pulmonary embolus, anemia or infection. Contrast-enhanced computed tomography (CT) of the abdomen revealed a massive arterial venous malformation (AVM) in the pelvis being fed from the left internal iliac artery with a caliber as large as the aorta with collateralization to the right internal iliac artery (Figures 1 and 2). Management of the arteriovenous fistula included embolization with Ivalon (IVALON PVA; Ivalon, San Diego, CA). Postprocedure CT angiography showed a marked reduction in the size of the arteries and veins within the malformation. The patient was symptomatically well at 6 months follow-up.