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Kim BJ, Kim GB, Lee SY. A child with spontaneous resolution of idiopathic mid-aortic syndrome presented with dilated cardiomyopathy. Cardiol Young 2024; 34:2477-2479. [PMID: 39618411 DOI: 10.1017/s1047951124036357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2025]
Abstract
Mid-aortic syndrome is an uncommon vascular disease characterised by lower thoracic and upper abdominal aorta stenosis and can occur even in neonatal or infant periods. Here, we report an interesting case of a 2-month-old female with diffuse hypoplasia of the lower abdominal aorta and secondary dilated cardiomyopathy. In our patient, her abdominal aortic narrowing spontaneously normalised over time with the administration of consistent and goal-directed heart failure therapy, supporting adequate growth and natural recovery.
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Affiliation(s)
- Beom Jae Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Al-Musawi M, Yuser A, AlOmaishi S, Kareem O, Rubay D. The Use of Systematic Clinical Approach in Diagnosing Rare Cases of Secondary Hypertension: A Case Report of Mid Aortic Syndrome in a Young Patient. Cureus 2021; 13:e19215. [PMID: 34745787 PMCID: PMC8562992 DOI: 10.7759/cureus.19215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/05/2022] Open
Abstract
Mid aortic syndrome (MAS) is a rare disease that occurs in children and young adults. The most important clinical feature reflecting vascular involvement is the presence of systemic hypertension. The diagnosis is usually made during the imaging assessment of secondary hypertension when routine echocardiography fails to identify the characteristic morphological or Doppler flow patterns associated with thoracic arch coarctation in the presence of the clinical features of aortic vascular obstruction. In this report, we present a case of a 22-year-old male who presented with systemic hypertension not responding to medical treatment, and whose systematic diagnostic workup revealed the diagnosis of MAS involving both renal arteries.
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Affiliation(s)
| | - Akeel Yuser
- Cardiovascular Surgery, Ibn AlNafees Center for Thoracic and Cardiovascular Surgery, Baghdad, IRQ
| | - Suhad AlOmaishi
- Internal Medicine, Life Alliance Organ Recovery Agency, University of Miami, Miami, USA
| | - Oula Kareem
- Department of Surgery, University of Colorado, Aurora, USA
| | - David Rubay
- Trauma and Surgical Critical Care, University of Florida College of Medicine, Gainesville, USA
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Peker O, Aki FT, Kumbasar U, Guvener M, Yılmaz M, Dogan R, Ozaltin F, Duzova A, Topaloglu R, Peynircioglu B, Demircin M. Surgical management of renovascular hypertension in children and young adults: a 13-year experience. Interact Cardiovasc Thorac Surg 2019; 29:746-752. [DOI: 10.1093/icvts/ivz157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 06/01/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES
In this study, we aimed to evaluate the early and mid-term outcomes of surgery for renovascular hypertension (RVH) at our institution, within the last 13 years.
METHODS
We retrospectively reviewed 19 patients who underwent surgery for RVH, between 2005 and 2017. The age at operation, clinical characteristics, cause of arterial stenosis, diagnostic workup, surgical management and outcomes during the follow-up were analysed. The continuous variables were expressed as mean ± standard deviation.
RESULTS
Twelve female and 7 male patients underwent surgery for RVH. Their mean age was 17.07 ± 11.9 years (range 4–42 years). Nine patients had renal arterial stenosis, and 10 patients had midaortic syndrome (MAS). Aortorenal bypass with the saphenous vein was performed in 6 patients with renal arterial stenosis and 1 patient with MAS. An isolated thoracic aorta-abdominal aortic bypass was performed in 1 patient with MAS, and thoracic aorta-abdominal aortic bypass combined with unilateral aortarenal bypass was performed in 9 patients with MAS. The other surgical procedures performed were 2 autotransplantations and 2 unilateral nephrectomies. Among the patients with MAS, 4 underwent reoperation. The mean follow-up duration was 45.58 ± 32.7 months. Hypertension was cured in 3 patients and improved in 14 patients. The postoperative follow-up creatinine levels were similar to preoperative creatinine levels. All bypasses were patent on mid-term follow-up. One patient who underwent aortorenal bypass died 14 months postoperatively.
CONCLUSIONS
Surgical management is a suitable option for patients with RVH, who were unresponsive to medical and/or endovascular management. Surgical methods are safe and effective in children and young adults with RVH.
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Affiliation(s)
- Oktay Peker
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Fazil Tuncay Aki
- Department of Urology, Hacettepe University Hospital, Ankara, Turkey
| | - Ulas Kumbasar
- Department of Cardiothoracic Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Murat Guvener
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Mustafa Yılmaz
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Rıza Dogan
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
| | - Fatih Ozaltin
- Department of Pediatric Nephrology, Hacettepe University Hospital, Ankara, Turkey
| | - Ali Duzova
- Department of Pediatric Nephrology, Hacettepe University Hospital, Ankara, Turkey
| | - Rezan Topaloglu
- Department of Pediatric Nephrology, Hacettepe University Hospital, Ankara, Turkey
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Metin Demircin
- Department of Cardiovascular Surgery, Hacettepe University Hospital, Ankara, Turkey
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Wilson S, Atnip R, Turner T, Wilson R. Application of Duplex Ultrasonography in the Midaortic Syndrome. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/154431671103500307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Midaortic syndrome is a rare condition found primarily in children that causes stenosis of the abdominal aorta and its proximal branches. Duplex interpretation criteria derived from adults do not necessarily apply to the pediatric population but are sometimes used empirically in specific cases. We report the case of a 5-year-old girl whose aorta and renal arteries were studied by duplex ultrasound, with anatomic and radiologic correlation. Case Report The patient was a 5-year-old girl with refractory hypertension on multiple antihypertensive medications. Her initial diagnosis of midaortic syndrome was made via duplex ultrasound. The findings were confirmed by angiography and showed smooth narrowing of the mid- to distal abdominal aorta with concomitant bilateral renal artery origin stenosis. Surgical repair of the aorta was performed with the use of a patch angioplasty technique with pulmonary artery homograft. The left renal artery was re-implanted onto the infrarenal aorta and an aorta to right renal artery bypass graft was placed using autogenous left internal iliac artery. Duplex ultrasound was then used to evaluate the success of the surgical repair. Conclusion Duplex ultrasound proved effective in the preoperative and postoperative care of this small child with midaortic syndrome and renal artery stenosis. The standard adult criteria for renal artery stenosis can be used selectively in children to assist in the diagnosis of unusual vascular conditions.
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Affiliation(s)
- Stephanie Wilson
- Vascular Sonography, South Hills School of Business and Technology, State College, Pennsylvania
| | - Robert Atnip
- Vascular Laboratory, Penn State Heart and Vascular Institute, The Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Tricia Turner
- Diagnostic Medical Sonography, South Hills School of Business and Technology, State College, Pennsylvania
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Chung H, Lee JH, Park E, Hyun H, Ahn YH, Jae HJ, Kim GB, Ha IS, Cheong HI, Kang HG. Long-Term Outcomes of Pediatric Renovascular Hypertension. Kidney Blood Press Res 2017; 42:617-627. [PMID: 28950261 DOI: 10.1159/000481549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 07/22/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Renovascular hypertension (RVHT) is an important cause of childhood hypertension. This study evaluated the clinical characteristics and outcomes of Korean children with RVHT. METHODS Children treated for RVHT between 2000 and 2015 at our center were retrospectively reviewed. RESULTS Forty-six children were followed for a median of 6.5 (0.66-27.23) years. Forty-five percutaneous transluminal angioplasties (PTAs) were performed in 32 children. At the last visit, clinical benefit was observed in 53.3% of children. Patients with comorbid cerebrovascular disease (CVD) showed less favorable long-term outcomes after PTA (clinical benefit in 41.7% vs. 61.1% in others) and higher restenosis rates (50% vs. 31.6% in others). Surgical procedures (bypass or nephrectomy) were performed in 8 patients. After surgery, blood pressure was normalized in 2 patients, improved in 3 patients, and unchanged in the remaining patients. Between PTA group (n=21) and medication group (n=14), percentage of atrophic kidneys became higher after follow-up period in medication group than in PTA group (60.0% vs. 26.1%, P=0.037). CONCLUSION Aggressive treatment of pediatric RVHT yielded fair outcomes in our cohort. CVD comorbidity was associated with relatively poor PTA outcomes. To confirm our findings, larger cohort studies with a longer follow-up period are warranted.
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Affiliation(s)
- Hyun Chung
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jae Hwan Lee
- Division of Intervention, Department of Radiology, National Cancer Center Hospital, Goyang, Republic of Korea
| | - Eujin Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Hyesun Hyun
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hwan Jun Jae
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Seoul National University, College of Medicine, Seoul, Republic of Korea
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Rumman RK, Nickel C, Matsuda-Abedini M, Lorenzo AJ, Langlois V, Radhakrishnan S, Amaral J, Mertens L, Parekh RS. Disease Beyond the Arch: A Systematic Review of Middle Aortic Syndrome in Childhood. Am J Hypertens 2015; 28:833-46. [PMID: 25631383 DOI: 10.1093/ajh/hpu296] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/13/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Middle aortic syndrome (MAS) is a rare clinical entity in childhood, characterized by a severe narrowing of the distal thoracic and/or abdominal aorta, and associated with significant morbidity and mortality. MAS remains a relatively poorly defined disease. This paper systematically reviews the current knowledge on MAS with respect to etiology, clinical impact, and therapeutic options. METHODS A systematic search of 3 databases (Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) yielded 1,252 abstracts that were screened based on eligibility criteria resulting in 184 full-text articles with 630 reported cases of childhood MAS. Data extracted included patient characteristics, clinical presentation, vascular phenotype, management, and outcomes. RESULTS Most cases of MAS are idiopathic (64%), 15% are associated with Mendelian disorders, and 17% are related to inflammatory diseases. Extra-aortic involvement including renal (70%), superior mesenteric (30%), and celiac (22%) arteries is common, especially among those with associated Mendelian disorders. Inferior mesenteric artery involvement is almost never reported. The majority of cases (72%) undergo endovascular or surgical management with residual hypertension reported in 34% of cases, requiring medication or reintervention. Clinical manifestations and extent of extra-aortic involvement are lacking. CONCLUSIONS MAS presents with significant involvement of visceral arteries with over two thirds of cases having renal artery stenosis, and one third with superior mesenteric artery stenosis. The extent of disease is worse among those with genetic and inflammatory conditions. Further studies are needed to better understand etiology, long-term effectiveness of treatment, and to determine the optimal management of this potentially devastating condition.
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Affiliation(s)
- Rawan K Rumman
- Institute of Medical Science and The Cardiovascular Sciences Collaborative Program, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cheri Nickel
- Hospital Library and Archives, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mina Matsuda-Abedini
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Surgery, Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Langlois
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Seetha Radhakrishnan
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Joao Amaral
- Faculty of Medicine, University of Toronto, Ontario, Canada; Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luc Mertens
- Faculty of Medicine, University of Toronto, Ontario, Canada; Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rulan S Parekh
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Ontario, Canada; Department of Medicine, University Health Network, Toronto, Ontario, Canada.
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Parikh P, Duhame D, Monahan L, Woroniecki R. Renal artery stenosis precipitates hyponatremic hypertensive syndrome and posterior reversible leukoencephalopathy. Front Pediatr 2015; 3:40. [PMID: 26000267 PMCID: PMC4423501 DOI: 10.3389/fped.2015.00040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hyponatremic hypertensive syndrome (HHS) is an uncommon disorder usually encountered in the adult population with unilateral renal artery stenosis and is under-recognized in the pediatric population. CASE DIAGNOSIS/TREATMENT A 19-month-old male presented with new-onset status epilepticus associated with neurological sequelae, and hypertension to a high of 248/150 mmHg. Lab work revealed significant hyponatremia, elevated peripheral renin activity, and increase in aldosterone and ADH levels. A diagnosis of HHS was made. Initial analysis revealed a high-grade proximal renal artery stenosis by magnetic resonance imaging (MRI) and angiogram. Electroencephalogram and an MRI of the brain demonstrated characteristic abnormalities of the left temporal-parietal regions consistent with posterior reversible leukoencephalopathy syndrome (PRES). The patient responded to right renal artery balloon dilation and stent placement. Since intervention and close blood pressure control with Amlodipine, the patient has been free of seizures and is neurologically intact. CONCLUSION We report a case of malignant hypertension in a 19-month-old male secondary to renal artery stenosis with associated HHS and PRES. Prognosis of PRES in children with renal disease is excellent. Prompt intervention may offer near complete resolution of physiologic and symptomatic effects of HHS and PRES due to high-grade renal artery stenosis. This report was written with parental consent for de-identified case presentation and radiographs for the educational benefit of other medical professionals.
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Affiliation(s)
- Pranav Parikh
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Danielle Duhame
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Laura Monahan
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
| | - Robert Woroniecki
- Department of Pediatrics, Stony Brook University School of Medicine , Stony Brook, NY , USA
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Voiculescu A, Heusch A, Düppers P, Pourhassan S, Klee D, Rump LC, Sandmann W. Duplex ultrasound findings before and after surgery in children and adolescents with renovascular hypertension. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2786-2793. [PMID: 25308948 DOI: 10.1016/j.ultrasmedbio.2014.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 06/04/2023]
Abstract
We report our experience with duplex ultrasound in young patients with renal artery stenosis (RAS) or middle aortic syndrome (MAS) before and after surgery (1995 and 2009). Of 36 patients (mean age: 13 ± 7 y), 21 had RAS and 15 had MAS. For patients with RAS, the Vmax in the affected artery was 350 ± 111 cm/s before surgery and 145 ± 55 cm/s after surgery. The resistance index was 0.46 ± 0.1 in the post-stenotic kidney and increased to 0.60 ± 0.08 after revascularization. Determination of the flow profile in the iliac artery revealed triphasic flow. In individuals with MAS, Vmax in the aorta was 323 ± 98 and the resistance index in both kidneys was low, even in the absence of RAS. The flow profile in the iliac arteries was monophasic before surgery and became triphasic after surgery. Duplex ultrasound is useful for the evaluation of children and young adults both pre- and post-surgery. Duplex ultrasound criteria for RAS in adults appear to be applicable in children and young adults also. The diagnostic evaluation of suspected renal vascular disease should include assessment of the aorta and the flow profile in the iliac arteries, as this could help differentiate between aortic and isolated renal artery stenosis.
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Affiliation(s)
- Adina Voiculescu
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA; Nephrology Department, University Hospital Dusseldorf, Dusseldorf, Germany.
| | - Andreas Heusch
- Paediatric Cardiology and Pulmonary Medicine, Helios Klinikum Wuppertal, Wuppertal, Germany
| | - Philip Düppers
- Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany
| | - Siamak Pourhassan
- Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany
| | - Dirk Klee
- Diagnostic and Interventional Radiology, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Lars C Rump
- Nephrology Department, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Wilhelm Sandmann
- Department of Vascular Surgery and Kidney Transplantation University Hospital Dusseldorf, Dusseldorf, Germany
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Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ, Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT, Lookstein RA, Lumsden AB, Newburger JW, Rundek T, Sperati CJ, Stanley JC. Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association. Circulation 2014; 129:1048-78. [PMID: 24548843 DOI: 10.1161/01.cir.0000442577.96802.8c] [Citation(s) in RCA: 292] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Peña Morillas L, Solanich Valldaura T, Peñas Juárez C, Barriuso Babot D, Giménez Gaibar A. Síndrome de aorta media en adulto joven. ANGIOLOGIA 2013. [DOI: 10.1016/s0003-3170(13)70076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Síndrome de aorta media. An Pediatr (Barc) 2011; 75:33-9. [DOI: 10.1016/j.anpedi.2011.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/16/2010] [Accepted: 01/22/2011] [Indexed: 11/21/2022] Open
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Lacombe M. Surgical Treatment of Renovascular Hypertension in Children. Eur J Vasc Endovasc Surg 2011; 41:770-7. [DOI: 10.1016/j.ejvs.2011.02.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/14/2011] [Indexed: 11/17/2022]
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Tullus K. Renal artery stenosis: is angiography still the gold standard in 2011? Pediatr Nephrol 2011; 26:833-7. [PMID: 21279728 DOI: 10.1007/s00467-010-1757-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 12/17/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
Abstract
Renovascular hypertension (RVH) is an unusual cause of hypertension in children that is important to diagnose as it is potentially curable with angioplasty or surgery. Digital subtraction angiography is the gold standard for diagnosing RVH; for other methods like ultrasound, isotope studies, magnetic resonance angiography and computed tomography angiography sensitivity is still too low to reliably exclude RVH. Clinical and laboratory criteria that suggest RVH will be proposed and recommendations when digital subtraction angiography should be performed will be made. A treatment algorithm that suggests when to use medical treatment, interventional radiology and surgery in children with RVH will be given.
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Lindblad B. Renovascular hypertension in children - time to further centralise handling? Eur J Vasc Endovasc Surg 2011; 41:778-9. [PMID: 21439858 DOI: 10.1016/j.ejvs.2011.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 02/25/2011] [Indexed: 11/29/2022]
Affiliation(s)
- B Lindblad
- Department of Vascular Diseases, Skåne University Hospital, Entrance 59, University Hospital MAS, 205 02 Malmo, Sweden.
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Kimura H, Sato O, Deguchi JO, Miyata T. Surgical treatment and long-term outcome of renovascular hypertension in children and adolescents. Eur J Vasc Endovasc Surg 2010; 39:731-7. [PMID: 20430657 DOI: 10.1016/j.ejvs.2010.03.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 03/15/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This article describes the long-term outcome of surgical treatment in children with renovascular hypertension (RVH) over a 40-year period. DESIGN Retrospective study. MATERIALS AND METHODS Twenty-five consecutive patients, aged 5-21 years, underwent renal artery (RA) repair from 1967 to 1995. The disease consisted of fibromuscular dysplasia in 17 patients, Takayasu's arteritis in 7 and neurofibromatosis type 1 in one patient. RESULTS Twenty-nine RAs were repaired. Primary procedures included aortorenal bypass (ARB) with prosthesis in 10 RAs, autologous vein in five or internal iliac artery in four as conduits, direct reimplantation (DR) in four and nephrectomy in two RAs. Immediate graft failure occurred in three patients despite no peri-operative deaths. After a mean follow-up of 24.4 years, seven patients required secondary nephrectomy. Autologous ARB or DR showed better RA patency and fewer chances for secondary nephrectomy than prosthetic ARB. Hypertension was cured or improved in 21 patients. The overall cumulative survival rate at 20 years was 84%. All five deaths, observed a mean of 12.6 years after the initial operation, were attributed to cardiovascular events. CONCLUSIONS Surgical treatment, especially autologous ARB or DR, seems to provide durable results for paediatric RVH. Long-term observation and control of hypertension is mandatory.
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Affiliation(s)
- H Kimura
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Stadermann MB, Montini G, Hamilton G, Roebuck DJ, McLaren CA, Dillon MJ, Marks SD, Tullus K. Results of surgical treatment for renovascular hypertension in children: 30 year single centre experience. Nephrol Dial Transplant 2009; 25:807-13. [DOI: 10.1093/ndt/gfp537] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Lindblad B, Lindh M, Ivancev K, Petersson U, Montgomery A. Novel Technique for Treatment of a Renal Artery Occlusion in a Child With Neurofibromatosis: A Combined Endovascular and Laparoscopic Approach. Vasc Endovascular Surg 2009; 43:199-206. [DOI: 10.1177/1538574408326263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Neurofibromatosis is associated with mid-aortic dysplasia, renal artery aneurysms and renal artery ostial stenosis, or occlusions in about 1% of cases. We describe a novel approach to recanalize an occluded renal artery in a 10-year-old girl with neurofibromatosis and difficulty in pharmacologically controlling her hypertension. Normally, when reconstruction is required, an open operative technique is used. We report on the combined use of laparoscopic exposure and percutaneous retrograde puncture of the occluded renal artery, which could be recanalized and stented. The pros and cons of this new approach are discussed.
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Affiliation(s)
- Bengt Lindblad
- Departments of Vascular Diseases, Endovascular Centre and General Surgery, University Hospital MAS, Malmö, Sweden,
| | - Mats Lindh
- Departments of Vascular Diseases, Endovascular Centre and General Surgery, University Hospital MAS, Malmö, Sweden
| | - Krassi Ivancev
- Departments of Vascular Diseases, Endovascular Centre and General Surgery, University Hospital MAS, Malmö, Sweden
| | - Ulf Petersson
- Departments of Vascular Diseases, Endovascular Centre and General Surgery, University Hospital MAS, Malmö, Sweden
| | - Agneta Montgomery
- Departments of Vascular Diseases, Endovascular Centre and General Surgery, University Hospital MAS, Malmö, Sweden
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Lin YJ, Hwang B, Lee PC, Yang LY, Meng CCL. Mid-aortic syndrome: A case report and review of the literature. Int J Cardiol 2008; 123:348-52. [PMID: 17321619 DOI: 10.1016/j.ijcard.2006.11.167] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Accepted: 11/18/2006] [Indexed: 10/23/2022]
Abstract
Renovascular disease is an important cause of secondary hypertension in children. In contrary to the adult patients whose major cause of renal artery stenosis (RAS) is atherosclerosis, fibromuscular dysplasia is responsible for the renovascular hypertension in most children. Mid-aortic syndrome (MAS) is a rare abnormality referring to an isolated disease of the distal thoracic and abdominal aorta resulting in significant tubular narrowing with stenosis of the visceral and renal arteries. It is usually diagnosed in young adults, but may present in childhood as a challenging problem. Patients with MAS are often first detected due to refractory hypertension. Other later presentations include intermittent claudication, congestive heart failure, renal insufficiency and symptoms of hypertensive associated end-organ damage. We report a case of a 16-year-old patient with MAS who suffered from malignant arterial hypertension. A percutaneous transluminal renal angioplasty (PTRA) was first performed, however the stenosis proved resistant to dilatation and only resulted in a minimal angiographic improvement. Due to persistent hypertension, an aortorenal bypass using the saphenous vein was performed. We also reviewed the literature on PTRA and the surgical management of RAS in MAS patients, in which PTRA often carries poor results.
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Matsumoto M, Suehiro K, Kubo H. Ascending aorta–abdominal aorta bypass with the reconstruction of superior mesenteric and bilateral renal arteries for mid-aortic syndrome. ACTA ACUST UNITED AC 2006; 54:535-8. [PMID: 17236657 DOI: 10.1007/s11748-006-0047-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the surgical repair of a case of mid-aortic syndrome (MAS) in a 17-year-old female patient. She was initially diagnosed with renovascular hypertension at the age of 12 years. Aortitis syndrome was suspected, and she has been treated with antihypertensive drugs since then. Angiography revealed severe stenosis of the abdominal aorta and left renal artery and occlusion of the right renal artery and superior mesenteric artery (SMA); this confirmed the diagnosis of MAS. Due to progressive, uncontrollable hypertension, we performed an ascending aorta-abdominal aorta bypass with revascularization of SMA and both renal arteries. Her blood pressure normalized following the operation.
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Affiliation(s)
- Mitsuaki Matsumoto
- Department of Cardiovascular Surgery, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan.
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König K, Gellermann J, Querfeld U, Schneider MBE. Treatment of severe renal artery stenosis by percutaneous transluminal renal angioplasty and stent implantation: review of the pediatric experience: apropos of two cases. Pediatr Nephrol 2006; 21:663-71. [PMID: 16520954 DOI: 10.1007/s00467-006-0010-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Revised: 09/30/2005] [Accepted: 10/04/2005] [Indexed: 11/27/2022]
Abstract
The clinical course of two children with mid-aortic syndrome and renal artery stenosis (RAS) who suffered from severe arterial hypertension is described. Hypertension was uncontrollable by antihypertensive medication and was managed by percutaneous transluminal renal angioplasty (PTRA) with stent implantation. The pediatric experience with PTRA is limited, and there are only few cases reported with additional stent implantation. Complications of these procedures are well known from experience with adult patients. However, since surgical revascularization may be technically difficult especially in small children, PTRA with or without stenting should be considered as a valuable treatment option in pediatric RAS.
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Affiliation(s)
- Kai König
- Department of Pediatric Nephrology, Charité University Hospital, Otto-Heubner-Centrum für Kinder- und Jugendmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
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Piercy KT, Hundley JC, Stafford JM, Craven TE, Nagaraj SK, Dean RH, Hansen KJ. Renovascular disease in children and adolescents. J Vasc Surg 2005; 41:973-82. [PMID: 15944596 DOI: 10.1016/j.jvs.2005.03.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This retrospective review describes the surgical management of renovascular disease in 25 consecutive children and adolescents with severe hypertension. METHODS Patients </=21 years of age (mean age, 11.6 +/- 5.4 years; 12 females, 13 males) underwent repair of 34 renal arteries (RAs), and their management forms the basis of this report. Early and late blood pressure responses were adjusted for gender, age, and height. RA repair was evaluated by angiography, renal duplex sonography (RDS) scanning, or both. Primary patency and survival were estimated by product-limit methods. RESULTS Thirty-four RAs among 32 kidneys were repaired. Bilateral renal RA disease to a solitary kidney was present in nine patients. RA lesions included dysplasia (44%), RA hypoplasia (20%), midaortic syndrome (12%), RA aneurysm (12%), dissection (8%), and arteritis (4%). All patients had severe hypertension (>95 th percentile systolic or diastolic pressure adjusted for gender, age, and height). RA repair comprised 25 bypasses (73%) consisting of 28% saphenous vein, 60% hypogastric artery, and 12% polytetrafluoroethylene; 2 patch angioplasties (6%), and 7 reimplantations (21%). Branch RA exposure was required in 28 kidneys (88%), and branch reconstruction was required in 61%. Warm in situ repair was used in 53%, in situ cold perfusion in 24%, and ex vivo cold perfusion in 23%. Of six bilateral RA repairs, one was staged and two patients are awaiting a staged repair. Combined aortic reconstruction was required in three patients. No unplanned nephrectomy was performed. There were no perioperative deaths. Hypertension was cured in 36%, improved in 56%, and failed in 8% at mean follow-up of 46.4 +/- 7.8 months. The mean calculated glomerular filtration rate increased from 82.0 mL/min/1.73 m 2 preoperatively to 98.2 mL/min/1.73 m 2 postoperatively. The postoperative patency of 30 RA reconstructions was evaluated by angiography, RDS scanning, or both. At mean follow-up of 32.8 months (median, 21.2 months), primary RA patency was 91%. No failures were observed after 2 months follow-up. Estimated survival was 100% at 60 months, with one death 9 years after surgery. CONCLUSIONS Renovascular hypertension in children and adolescents was caused by a heterogeneous group of lesions. All patients had RA repair, with arterial autografts in most of the RA bypasses. Cold perfusion preservation was used in half of the complex branch RA repairs. These strategies provided 91% primary patency at mean follow-up of 32.8 months, with beneficial blood pressure response in 92%. Surgical repair of clinically significant renovascular disease in children and adolescents is supported by these results.
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Affiliation(s)
- K Todd Piercy
- Division of Surgical Sciences, Section on Vascular Surgery, Wake Forest University School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1095, USA
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Johal NS, Kraklau D, Cuckow PM. The role of unilateral nephrectomy in the treatment of nephrogenic hypertension in children. BJU Int 2005; 95:140-2. [PMID: 15638912 DOI: 10.1111/j.1464-410x.2004.05266.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To define the efficacy of unilateral nephrectomy in a large series of patients presenting with renal disease and hypertension, as the latter may be a prominent finding in children with nephrourological disease (renal parenchymal disease, renovascular disease, obstruction, renal dysplasia and cancer). PATIENTS AND METHODS We retrospectively reviewed the hospital and outpatient records of 118 children who presented for evaluation with hypertension, and who had a nephrectomy between 1968 and 2003. Patients included in the study were those who had a unilateral nephrectomy for benign renal hypertension with a normal contralateral kidney; in all, 21 had complete records and follow-up were evaluated. The hypertension was associated with primary renal disease, obstruction and renovascular disease. Blood pressure and medication requirements were compared before and after surgery, the blood pressure values also being compared with published nomograms. RESULTS Patients were diagnosed with hypertension at a median age of 5 years and had a nephrectomy at a median of 11 months after the diagnosis. The median follow-up after surgery was 39 months. Most patients responded well and became normotensive, or there was a reduction in the need for medication. The median time to normalization was 2, 10 and 11 days in patients with primary renal disease, obstruction and renovascular disease, respectively. CONCLUSION Nephrectomy is successful in normalizing blood pressure in children with benign renal hypertension and with a normal contralateral kidney.
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Affiliation(s)
- Navroop S Johal
- Department of Paediatric Urology, Great Ormond Street Hospital, UK.
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Dixit MP, Hughes JD, Theodorou A, Dixit NM. Hyponatremic hypertensive syndrome (HHS) in an 18-month old-child presenting as malignant hypertension: a case report. BMC Nephrol 2004; 5:5. [PMID: 15113447 PMCID: PMC420241 DOI: 10.1186/1471-2369-5-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2003] [Accepted: 04/27/2004] [Indexed: 11/10/2022] Open
Abstract
Background The combination of hyponatremia and renovascular hypertension is called hyponatremic hypertensive syndrome (HHS). Malignant hypertension as a presentation has been reported in adults with HHS but is rare in children. Case presentation An eighteen month-old male presented with drowsiness, sudden onset status epilepticus and blood pressure of 210/160. The electrolytes on admission revealed sodium of 120 mEq/L and potassium of 2.1 mEq/L. The peripheral renin activity (PRA) was 172 ng/ml/min (normal 3–11 ng/ml/min) and serum aldosterone level was 91 ng/dl (normal 4 to 16 ng/dl). Patient underwent angioplasty with no success, followed by surgical correction. Two years since the diagnosis, the blood pressure is controlled with labetolol and amlodipine (at less than sixth of the pre-operative dosages). The PRA is 2.4 ng/ml/min and aldosterone 15.5 ng/dl. The child not only had three renal arteries on left but all of them were stenosed which to best of our knowledge has not been described. Conclusion As uncommon as HHS with malignant hypertension may be in adults it is under-reported in children and purpose of the case report is to raise its awareness.
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Affiliation(s)
- Mehul P Dixit
- Steele Memorial Children's Research Center, Department of Pediatrics, University of Arizona, Tucson, USA
| | - John D Hughes
- Vascular Surgery, University of Arizona, Tucson, USA
| | - Andreas Theodorou
- Steele Memorial Children's Research Center, Department of Pediatrics, University of Arizona, Tucson, USA
| | - Naznin M Dixit
- Steele Memorial Children's Research Center, Department of Pediatrics, University of Arizona, Tucson, USA
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Lesiones vasculares múltiples y precoces en la neurofibromatosis. Descripción de un caso clínico y revisión bibliográfica. ANGIOLOGIA 2002. [DOI: 10.1016/s0003-3170(02)74750-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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García Noain J, Martínez-Berganza Asensio A, Cía Gómez P. Emergencia hipertensiva de origen vasculorrenal como manifestación clínica inicial en una mujer joven. HIPERTENSION Y RIESGO VASCULAR 2001. [DOI: 10.1016/s1889-1837(01)71205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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