Heart failure 63 years after traumatic arteriovenous fistula

Congestive heart failure developed in a patient 63 years after an initial bullet wound, sustained at age 12, and a subsequently acquired arterlovenous fistula of the left thigh. This is the longest reported interval between formation of an acquired arterlovenous fistula and development of cardiac decompensation. Clinical improvement after surgical closure of the fistula was dramatic. Objective evidence of improvement was documented with serial echocardiograms.