High-Output Heart Failure Due to a Renal Arteriovenous Fistula in a Pregnant Woman With Suspected Preeclampsia Tommy S. Korn, M.D., Jeffrey M. Thurston,

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High-Output Heart Failure Due to a Renal Arteriovenous Fistula in a Pregnant Woman With Suspected Preeclampsia Tommy S. Korn, M.D., Jeffrey M. Thurston, M.D., Cynthia S. Sherry, M.D., Darryl L. Kawalsky, M.D. Mayo Clinic Proceedings Volume 73, Issue 9, Pages 888-892 (September 1998) DOI: 10.4065/73.9.888 Copyright © 1998 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Contrast-enhanced computed tomogram at renal hilar level, showing asymmetry of nephrograms, relatively delayed on right, and marked enhancement of tortuous large-caliber vessels filling renal pelvis and approaching distended inferior vena cava. AVF = arteriovenous fistula. Mayo Clinic Proceedings 1998 73, 888-892DOI: (10.4065/73.9.888) Copyright © 1998 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Subtraction image from aortogram, showing pooling of contrast medium in giant vascular channels, resulting in early filling of distended inferior vena cava (IVC), compatible with arteriovenous shunting. Enlarged tributaries extend radially. Pressure within IVC equaled that within aorta. Selective catheterization of renal vein resulted in repeated deflection of catheter back into IVC because of marked turbulence of flow. IVC was dilated with a diameter 3 times larger than diameter of aorta. AC = aortic catheter; AVF = arteriovenous fistula. Mayo Clinic Proceedings 1998 73, 888-892DOI: (10.4065/73.9.888) Copyright © 1998 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Gross specimen of 250-g distorted kidney, 10 by 9 by 5.5 cm, with small amount of attached perirenal fat. Specimen is bivalved to reveal aneurysm, 5 by 5 by 4.5 cm, that appeared to communicate with renal artery. (Photograph courtesy of Dr. Beverly A. Dickson.) Mayo Clinic Proceedings 1998 73, 888-892DOI: (10.4065/73.9.888) Copyright © 1998 Mayo Foundation for Medical Education and Research Terms and Conditions