HEMODYNAMIC EFFECTS OF A-V FISTULA IN CHILDREN

Chronic renal failure (CRF, is characterized by the deterioration of excretion and endocrine function of the kidney . Cardiac preload and afterload at isotropic period are influenced by these changes. Hemodialysis (HD) affects the left ventricle (L V) function in acute period. It is not clear that the effect of A-V fistula on the cardiovascular system in CRF patient. It was aimed in this study to examine the cardiac functions before and after A-V fistula and effect of A-V fistulae on cardiac system in children. Ten patients with CRF (5 girls, 5 boys), aged 5-12 years were included in the study. A-V fistula were performed by Brescia-Cimino shunt technique. Cardiac functions were evaluated by telecardiogram, electrocardiography (ECG), echocardiography (Hewlett-Packard Sonos 1000 2D Doppler ECO), before (mean: 17.8±12.9 days) and after (mean: 53.9±12.6 days) performing A-V fistula. All cases were taken in HD program with 0.8-1 m cuprophane membrane in 302 Toray HD machine three times a week. No changes in ECG and telecardiogram were observed. In ECO cardiography evaluation, left ventricul end systolic diameter (before: 2.76±0.44, after: 3.02±0.9mm/m2) ve end diastolic diastolic diameter (before: 4.15±0.65, after: 4.45±1.06 mm/m2), the thickness ofposteior wall (before: 0.92±0.30, after: 0.76±0.20) and interventriculer septum (before: 0.77±0.27, after:0.27, after: 0.81±0.25), width of aorta (before: 2.33±0.48, after 2.21 ±0.40) and ejection fractions (before: 61.40±12.26, after: 63.30^13.86) were measured but no significant difference was found in statistical analysis. These results implicated that A- V fistula do not lead to any changes in systolic functions within two months and in acuted period early cardiac dysfunction begins with early changes in the diastole in childhood.