# Severe Left Ventricular Outflow Tract Obstruction Following Arteriovenous Fistula Reopening in a Dialysis Patient With Left Ventricular Hypertrophy

## TL;DR

A dialysis patient with heart issues experienced severe heart complications after reopening an arteriovenous fistula, which improved after the fistula was closed.

## Contribution

This case highlights the risks of AVF reopening in patients with preexisting left ventricular hypertrophy.

## Key findings

- AVF reopening led to severe LVOT obstruction and mitral regurgitation in a patient with left ventricular hypertrophy.
- Symptoms and echocardiographic abnormalities resolved after surgical AVF closure.
- The case underscores the need for cardiovascular evaluation before AVF reopening in at-risk patients.

## Abstract

Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis due to their durability and lower risk of complications than alternative access methods. However, AVFs can significantly impact cardiac function, particularly in patients with preexisting cardiovascular conditions. We present a case of a 56-year-old female with a history of hypertension and end-stage renal disease who developed recurrent hypotension, dizziness, and dyspnea following AVF reopening. The echocardiographic evaluation revealed severe left ventricular hypertrophy, systolic anterior motion of the mitral valve, significant mitral regurgitation, and left ventricular outflow tract (LVOT) obstruction with a high-pressure gradient. Despite medical management with beta-blockers, symptoms persisted, leading to the decision to close the AVF surgically. Following AVF closure, echocardiography showed a marked improvement in mitral regurgitation and resolution of LVOT obstruction, with the patient tolerating subsequent dialysis without complications. This case highlights the potential hemodynamic consequences of AVF reopening in patients with underlying cardiac pathology and emphasizes the need for careful cardiovascular evaluation.