Tyagi S, Kaul U A, Satsangi D K, Arora R
Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
Pediatrics. 1997 Jan;99(1):44-9. doi: 10.1542/peds.99.1.44.
To evaluate the efficacy and safety of percutaneous transluminal renal angioplasty (PTRA) in children.
We performed aortography and attempted PTRA in 35 consecutive children (age 5 to 14 years, mean 10.8 +/- 2.5 years) with severe hypertension having > or = 75% renal artery stenosis (RAS).
The stenosis was caused by aortoarteritis in 31 (88.6%) cases and by juvenile idiopathic fibromuscular disease (FMD) in four (11.4%) cases. Twenty-seven (77.1%) patients, including three having RAS of solitary functioning kidney with total occlusion of contralateral renal artery, had bilateral RAS and eight (22.9%) had unilateral RAS. PTRA was technically successful in 54 (91.5%) of 59 stenotic lesions in 31 (88.6%) of 35 patients. Both aortoarteritis and FMD patients had significant decrease in RAS after PTRA. One patient had acute reocclusion of one renal artery after bilateral PTRA, which could be successfully opened by reangioplasty. Postangioplasty angiographic restudy performed in 18 patients at 4 to 72 months (mean 23.1 +/- 27.9 months) after successful angioplasty showed restenosis in 8 (25.8%) of 31 lesions initially dilated and de novo lesions of aorta in two patients. All seven restenotic renal artery lesions attempted and both stenosis of aorta were successfully dilated. Twenty-nine of 31 patients with successful PTRA have been followed up from 4 to 108 months (mean 41.0 +/- 29.3 months). Mean systolic blood pressure decreased from 185.1 +/- 27.4 to 120.6 +/- 19.2 mm Hg and mean diastolic blood pressure decreased from 118.4 +/- 13.2 to 84.6 +/- 10.4 mm Hg after PTRA. Twenty seven (93.1%) of these 29 patients had benefical blood pressure response. Seventeen (58.6%) patients improved, 10 (34.5%) were cured, although 2 (6.9%) patients failed to respond to PTRA. Blood pressure response was better in FMD as compared to aortoarteritis group. Patients with unilateral RAS, discrete stenosis, and post-PTRA stenosis < or = 20% also identified good blood pressure response.
Aortoarteritis is the most common cause of renovascular hypertension in South Asian children. PTRA is safe and highly effective and therefore should be the treatment of choice in pediatric renovascular hypertension.
评估经皮腔内肾血管成形术（PTRA）治疗儿童肾血管性高血压的疗效和安全性。
对35例年龄5至14岁（平均10.8±2.5岁）、肾动脉狭窄（RAS）≥75%的严重高血压患儿进行主动脉造影并尝试PTRA。
31例（88.6%）狭窄由大动脉炎引起，4例（11.4%）由青少年特发性纤维肌性疾病（FMD）引起。27例（77.1%）患者为双侧RAS，包括3例单功能肾合并对侧肾动脉完全闭塞的RAS患者，8例（22.9%）为单侧RAS。35例患者中59处狭窄病变，54处（91.5%）技术上PTRA成功。大动脉炎和FMD患者PTRA后RAS均显著降低。1例患者双侧PTRA后一侧肾动脉急性再闭塞，再次血管成形术成功开通。18例患者在成功血管成形术后4至72个月（平均23.1±27.9个月）进行血管造影复查，最初扩张的31处病变中有8处（25.8%）出现再狭窄，2例患者出现主动脉新生病变。所有7处再狭窄的肾动脉病变及2处主动脉狭窄均成功扩张。31例PTRA成功的患者中29例随访4至108个月（平均41.0±29.3个月）。PTRA后平均收缩压从185.1±27.4降至120.6±19.2 mmHg，平均舒张压从118.4±13.2降至84.6±10.4 mmHg。这29例患者中27例（93.1%）血压反应良好。17例（58.6%）改善，10例（34.5%）治愈，2例（6.9%）患者对PTRA无反应。与大动脉炎组相比，FMD患者血压反应更好。单侧RAS、局限性狭窄及PTRA后狭窄≤20%的患者血压反应也良好。
大动脉炎是南亚儿童肾血管性高血压最常见的病因。PTRA安全且高效，因此应成为儿童肾血管性高血压的首选治疗方法。
