Isomura T, Yamana K, Hisatomi K, Akashi H, Konishi H, Kousaka I, Ihara T, Kashikie H, Inuzuka H, Noda S
Second Department of Surgery, Kurume University School of Medicine.
Kyobu Geka. 1990 Jan;43(1):36-40.
We have experienced two patients of ischemic heart disease associated with renovascular hypertension. Patient 1 (60-year-old man) underwent LV aneurysmectomy and triple aortocoronary bypass grafting (saphenous vein to diagonal branch, left internal mammary artery to obtuse marginal branch, and right gastroepiploic artery to right coronary artery). Seventy five days after the initial cardiac surgery endarterectomy for the left renal artery and bifurcated Dacron graft implantation for the iliac artery obstruction were performed. Patient 2 (62-year-old woman) underwent simultaneous operation of both right nephrectomy and triple aortocoronary bypass grafting (saphenous vein grafts to obtuse marginal branch and right coronary artery, and left internal mammary artery to left anterior descending artery). Their postoperative courses were uneventful except unstable and high blood pressure for four to seven days after the operation. It appears that it should be decided to achieve either simultaneous or two stage approach for ischemic heart disease associated with renovascular hypertension based on the preoperative cardiac function. And both postoperative cardiac function and hypertension should be carefully managed until the blood pressure becomes stable after the surgery.
我们遇到过两名患有缺血性心脏病合并肾血管性高血压的患者。患者1（60岁男性）接受了左心室动脉瘤切除术和三联主动脉冠状动脉搭桥术（大隐静脉至对角支、左乳内动脉至钝缘支、右胃网膜动脉至右冠状动脉）。在初次心脏手术后75天，进行了左肾动脉内膜切除术和髂动脉阻塞的分叉涤纶移植血管植入术。患者2（62岁女性）接受了右肾切除术和三联主动脉冠状动脉搭桥术（大隐静脉移植至钝缘支和右冠状动脉，左乳内动脉至左前降支）的同期手术。他们的术后病程顺利，只是术后四到七天血压不稳定且偏高。似乎应该根据术前心功能来决定对缺血性心脏病合并肾血管性高血压采用同期还是分期手术方法。并且在术后血压稳定之前，应仔细管理术后心功能和高血压情况。
