PubMed · 1130467
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J V Platt, C E Goodman, J A Cavanaugh. 1975. A shunt shield.. https://pubmed.ncbi.nlm.nih.gov/1130467/
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Cardiovascular complications are frequent and related to left ventricular (LV) hypertrophy and dysfunction in end-stage renal disease. To examine cardiac changes after renal transplantation, 24 hemodialysis patients (18 men and 6 women, age 47 +/- 12 years) were analyzed in a prospective follow-up study with echocardiography immediately before and 41 +/- 30 months after renal transplantation. Mean systolic blood pressure (hemodialysis vs transplantation: 156 +/- 35 vs 144 +/- 15 mm Hg; p = not significant [NS]), as averages of 6 measurements from 2 weeks, remained constant and elevated. The most frequent echocardiographic findings at both assessments were left atrial dilatation (75 vs 79%; p = NS) and LV hypertrophy (71 vs 67%; p = NS). After transplantation, an increase was found in mean left atrial diameter (41 +/- 5 to 44 +/- 5 mm; p < 0.05) and end-diastolic LV diameter (50 +/- 5 to 53 +/- 5 mm; p < 0.05) at constant LV muscle mass (332 +/- 104 vs 329 +/- 94 g; p = NS). LV ejection fraction (58 +/- 10% to 63 +/- 12%; p < 0.02) and stroke volume (98 +/- 26 to 118 +/- 25 ml; p < 0.02) improved. No influence of blood pressure in sporadic morning determinations or of dialysis fistula patency on alterations of LV mass or function was found. Left atrial diameters increased in patients with patent dialysis fistulas (41 +/- 7 to 45 +/- 5 mm; p < 0.05), but not in those with occluded fistulas (41 +/- 7 vs 42 +/- 4 mm; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)
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A case of untreated hypertension in a patient, where blood pressure could be measured in the right arm only is presented. At autopsy, the brachio-cephalic artery was found to be occluded explaining why blood pressure values were low. Significant left ventricular hypertrophy indicating high central blood pressure was found. Sudden death followed a spontaneous intracerebral bleeding. The value of conventional blood pressure measurement in patients with arteriovenous shunt because of chronic dialysis is discussed.