[Severe left heart failure long after acquired arteriovenous fistula].

Gunshot wounds and traumatic injuries are the main causes of acquired arteriovenous fistulas. The high cardiac output associated with such fistulas depends mainly on the size of the pathological communication and the degree of reduction in the systemic vascular resistance that results. Since the findings on cardiac examination in these patients may mimic those of valvular heart disease or dilated cardiomyopathy, careful attention should be paid to noncardiac physical findings, such as thrill and/or continuous murmur over the traumatic or surgical scar. We describe a 64-year-old man who developed severe left heart failure 39 years after a gunshot injury in the left lower quadrant of the abdomen. This had led to an acquired arteriovenous fistula between the left internal iliac artery and the left common iliac vein.