title: Reverse cardiac remodelling and renal functional improvement following bilateral renal artery stenting for flash pulmonary oedema.
abstract: Acute flash pulmonary oedema (AFPO) is a life-threatening syndrome almost unique to patients with atheromatous renovascular disease (ARVD). Although recurrent AFPO is a widely accepted indication to consider renal revascularization, this is based on a number of case reports/series describing a successful outcome post-procedure. There is limited literature on the pathophysiological mechanisms and treatment effects of revascularization to support this clinical decision making. We report the case of a 65-year-old lady who presented with three episodes of AFPO. Investigations revealed severe bilateral renal artery stenosis. Post-revascularization, she experienced substantial improvement in energy levels and New York Heart Association class, with improvement in her blood pressure and renal function. Post-procedure, there were dramatic improvements in her cardiac morphology and function that were sustained at 1 year (ejection fraction improved from 39 to 65%, left ventricular mass decreased from 161 to 116 g) as well as renal function (isotopic glomerular filtration rate increased from 22.4 to 34.2 mL/min). This report provides new insights into the pathophysiological relationships between renal and cardiac changes in AFPO; the extent of the cardiac morphological changes was striking and unexpected.
authors.affiliation: Manchester Academic Health Science Centre, Renal Department, Salford Royal Hospital, The University of Manchester, Salford, UK. tinachrys@doctors.org.uk
authors.forename: Constantina
authors.initials: C
authors.lastname: Chrysochou
authors.forename: Matthias
authors.initials: M
authors.lastname: Schmitt
authors.forename: Kirk
authors.initials: K
authors.lastname: Siddals
authors.forename: Julie
authors.initials: J
authors.lastname: Hudson
authors.forename: Alan
authors.initials: A
authors.lastname: Fitchet
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D011654:Pulmonary Edema / Q000209:etiology / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D020257:Ventricular Remodeling / Q000502:physiology*