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      Improvement of left ventricular filling and pulmonary artery pressure following unilateral renal artery total occlusion stenting in a patient with recurrent congestive heart failure complicated by renovascular hypertension and renal failure

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          Abstract

          Recurrent congestive heart failure related to renal artery disease is an important clinical entity that is typically observed in bilateral renal artery stenosis or solitary functioning kidney. However, the relationship between heart failure and unilateral renal artery disease, especially that with total occlusion, remains unclear. We report a successful management by unilateral renal artery total occlusion stenting with an evidence of improvement of left ventricular filling and pulmonary artery pressure in case of a patient suffering from medical therapy resistant recurrent congestive heart failure with preserved ejection fraction.

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          Most cited references16

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          Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome.

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            SCAI expert consensus statement for renal artery stenting appropriate use.

            The pathophysiology of atherosclerotic renal artery stenosis (RAS) includes activation of the renin-angiotensin-aldosterone axis with resultant renovascular hypertension. Renal artery stenting has emerged as the primary revascularization strategy in most patients with hemodynamically significant atherosclerotic RAS. Despite the frequency with which hemodynamically significant RAS is observed and high rates of technical success of renal artery stenting, there remains considerable debate among experts regarding the role of medical therapy versus revascularization for renovascular hypertension. Modern, prospective, multicenter registries continue to demonstrate improvement in systolic and diastolic blood pressure with excellent safety profiles in patients with RAS. Modern randomized, controlled clinical trials of optimal medical therapy versus renal stenting particularly designed to demonstrate preservation in renal function after renal artery stenting have demonstrated limited benefit. However, these trials frequently excluded patients that may benefit from renal artery stenting. This document was developed to guide physicians in the modern practical application of renal stenting, to highlight the current limitations in the peer-reviewed literature, to suggest best-practices in the performance of renal stenting and to identify opportunities to advance the field.
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              Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis.

              Renal artery stenosis (RAS) impacts the pathogenesis and control of heart failure (HF) and may further contribute to increased cardiovascular morbidity and mortality in HF patients. However, the long-term effects of renal artery revascularization on cardiovascular outcomes in HF patients are not well studied. The prevalence of HF and its effects on all-cause mortality were studied in 163 consecutive patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/dL) who underwent percutaneous transluminal renal angioplasty (PTRA) with stenting for atherosclerotic RAS. In addition, in 100 patients with RAS and coexistent HF, we compared the impact of medical treatment (n = 50) versus PTRA (n = 50) on clinical outcomes. HF (predominantly normal ejection fraction) was present in 50/163 (31%) patients with systemic hypertension and chronic kidney disease (serum creatinine >2 mg/ dL) undergoing PTRA for RAS and represented the major predictor of all-cause mortality in these patients. When compared with sex-matched RAS and HF patients treated medically, PTRA with stenting was associated with a significant decrease in the New York Heart Association Functional Class (1.9 +/- 0.8 versus 2.6 +/- 1.0, P < 0.04) and a 5-fold reduction in the number of hospitalizations. However, renal artery revascularization did not impact mortality. HF was present in one-third of patients with renal dysfunction and atherosclerotic RAS who were referred for PTRA. The presence of HF was associated with a significantly increased risk of death after PTRA with stenting. Renal artery revascularization resulted in improved HF control and a reduction in HF hospitalizations.
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                Author and article information

                Journal
                ESC Heart Fail
                ESC Heart Fail
                10.1002/(ISSN)2055-5822
                EHF2
                Esc Heart Failure
                John Wiley and Sons Inc. (Hoboken )
                2055-5822
                20 October 2015
                December 2015
                : 2
                : 4 ( doiID: 10.1002/ehf2.v2.4 )
                : 160-163
                Affiliations
                [ 1 ] Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center OsakaJapan
                [ 2 ] Department of Cardiovascular Medicine, Graduate School of Medical SciencesKumamoto University KumamotoJapan
                Author notes
                [*] [* ]Correspondence to: Osami Kawarada, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5‐7‐1 Fujishiro‐dai, Suita, Osaka 565‐8565, Japan. Tel: +81‐6‐6833‐5012. Fax: +81‐6‐6872‐7486. E‐mail: kawarada.osami.hp@ 123456ncvc.go.jp
                Article
                EHF212069 ESCHF-2015-02-0018.R3
                10.1002/ehf2.12069
                5057347
                ab5e7f6b-dc24-40f4-a08b-de0e6a0ef504
                © 2015 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 28 February 2015
                : 23 August 2015
                : 26 August 2015
                Page count
                Pages: 4
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                ehf212069
                ehf212069-hdr-0001
                December 2015
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.4 mode:remove_FC converted:12.10.2016

                hfpef,unilateral renal artery disease,total occlusion,stent,left ventricular filling,pulmonary artery pressure

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