Postlaminectomy arteriovenous fistula. Suspected by bedside data from right-side heart catheterization.

We describe a patient with long-standing left and right ventricular failure whose underlying arteriovenous (AV) fistula was not suspected until a bedside right-side See also editorial p 1151. heart catheterization disclosed an elevated mixed venous oxygen pressure (PvO 2 ). REPORT OF A CASE A 65-year-old man with a two-year history of refractory congestive heart failure and left iliac thrombophlebitis was admitted with pulmonary edema to the McGuire Veterans Administration Hospital, Richmond, Va. The patient was in severe respiratory distress, with findings of biventricular failure. A systolic abdominal bruit, noted previously, was heard in the left lower abdominal quadrant and also below an old laminectomy scar in the lumbosacral region. His left leg was twice the size of his right and there were findings of chronic vascular insufficiency. A chest roentgenogram showed marked cardiomegaly and bilateral interstitial and alveolar infiltrates. A balloon-tipped flow-directed catheter was inserted into the right side of