High-Output Heart Failure Resulting From Chronic Aortocaval Fistula

A 61-year-old man was admitted to the hospital complaining of bilateral leg edema and dyspnea lasting for 1 month and resistant to diuretic therapy. His past medical history included hypertension, smoking, pneumonia, and chronic alcoholism. There was no history of abdominal trauma. The heart rate was 110 beats per minute (bpm), and blood pressure was normal (135/75 mm Hg). Physical examination also revealed clinical signs of right heart failure, including peripheral edema, hepatomegaly, jugular vein dilatation, ascites, and right pleural effusion. There were no signs of portal hypertension or hepato-cellular insufficiency. There was no pulsatile mass nor abdominal murmur. The liver tests revealed moderate cytolysis and cholestasis and an elevated brain natriuretic peptide value of 1322 pg/mL (normal value <500 pg/mL). Complete blood count, hemostasis, renal function, and …