doiSerbia

"Flash" pulmonary oedema as a clinical manifestation of renovascular hypertension

Kalimanovska-Oštrić Dimitra V. (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Ivanović Branislava (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Oštrić Vladimir Z. (Institut za nefrologiju i urologiju, Klinički centar Srbije, Beograd)
Knežević Vesna (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Stojanov Vesna J. (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Simić Dragan V. (Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

One of the clinical manifestations of renovascular hypertenzion (RVH) may be a recurrent pulmonary oedema both in the absence or in the presence of systolic left ventricular dysfunction. This type of pulmonary oedema characterized as "flash" pulmonary oedema is ascribed to elevated angiotensin II concentrations with consequent hypertension as well as to volume overload resulting from decreased pressure natriuresis when there are significant stenoses of both or one renal arteries. The investigation included 30 patients with RVH treated by percutaneous transluminal angioplasty of the stenosed renal artery (PTRA) and/or stent implantation (PTR-ST) and 30 patients with surgical resection of the abdominal aortic aneurysm (AAA). The first group was divided in two subgroups according to the etiology of renal artery stenosis (RAS). In the subgroup with fibromuscular dysplasia (FMD) the mean age was 37.5 years, in the subgroup with atherosclerotic renal artery stenosis (ARAS) 54.8 years and in the group with operated AAA 68.6 years. There were more females than males only in the FMD subgroup (10:3). Two patients of the first group experienced pulmonary oedema, both in the subgroup with atherosclerotic renal artery stenosis associated with atherosclerosis of other arteries. Normalization of the blood pressure following PTRA in both and an uncomplicated course after a surgical myocardial revascularization in one of them illustrates the importance of renal revascularization. Pulmonary oedema occurred preoperatively in four out of 30 patients with abdominal aortic aneurysm in whom significant renal artery stenoses coexisted. Two patients died despite surgery, one patient is clinically stable and the medicament treatment of heart failure is inevitable in the fourth with a left ventricular aneurysm following myocardial infarction. The occurrence or reoccurrence of pulmonary oedema in the absence of other explanation should suggest the possibilty of billateral or unilateral renal artery stenosis requiring renal revascularization for blood pressure regulation as well as for elimination of other manifestations/complications.

Keywords: "flash" pulmonary oedema, renovascular hypertension, renal artery stenosis, renal revascularization