Abstract
We report an infant with congestive heart failure secondary to an arteriovenous fistula of the abdmoinal wall. The patient was refered to our hospital on the 4th day of life because of tachypnea and poor feeding. After further examinations including abdominal aortography, we diagnosed the disorder as an arteriovenous fistula of the abdominal wall, located between the bilateral hypogastric arteries and the umbilical vein. We ligated the feeding arteries and the drainage vein. After the operation, distension of the abdominal wall developed progressively. Serum transaminase level rose to over a hundred times greater than normal, and the infant's blood was concentrated. We believed that these symptoms represented plasma transudation caused by hemostasia in the arteriovenous fistula. We untied of the umbilical vein. The infant's postoperative course was satisfactory and he was discharged from our hospital on the 42nd day after the reoperation. Three months after the reoperation, blood flow in the umbilical vein was normal according to noninvasive examinations. Arteriovenous fistula of the abdominal wall is very rare. To our knowledge, previous reported cases number only three, and we believe this is the first report in Japan. Congenital arteriovenous fistula is rare, but may cause severe congestive heart failure in infants. The objective of surgical treatment is reduction of the heart failure. We ligated the feeding arteries, but did not resect the arteriovenous fistula. This method was less stressful and appeared to be appropriate for the control of heart failure caused by arteriovenous fistula.
