To The Editor.—
The recent case report in the Archives by Siegel et al (137:83-84, 1977) and accompanying editorials (137:25-27, 1977) explore the place of coronary bypass surgery in the therapeutic regimen of the nephrologist. From a purely medical viewpoint, there is no question that this procedure may ameliorate symptoms of angina in selected patients1-3 and can safely be performed on patients receiving hemodialysis.4-6The authors of the case report and the editorials fail to note, however, that this patient's symptoms of angina progressively worsened after creation of an arteriovenous (AV) fistula. No mention is made of prefistula or postfistula cardiac output (CO) studies, but a substantial increase in cardiac output, sufficient to cause heart failure has been reported following AV fistula creation.7,8 A simple and economically feasible way of evaluating patients receiving hemodialysis with severe angina might be to first measure CO before and after temporary
Nissenson AR. Coronary Surgery and Hemodialysis. Arch Intern Med. 1977;137(6):813. doi:10.1001/archinte.1977.03630180085029
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