[MO-60] Presentation Awards
A case of primary aldosteronism due to aldosterone-producing adenoma post partial adrenalectomy with the reference of modified segmental-adrenal vein sampling familiar to cardiovascular interventionist.
The case was a 44-year-old hypertensive male who had a right adrenal mass in the posterior adrenal gland with hypokalemia and a high plasma aldosterone concentration ratio to plasma renin activity. Captopril stress test confirmed the diagnosis of primary aldosteronism (PA). Patient desired partial adrenalectomy. Subsequently, detail localization of aldosterone-producing adenoma is evaluated with preoperative segmental adrenal vein sampling (S-AVS).
The micro-wire and the micro catheter were advanced to the segmental adrenal vein using a percutaneous coronary intervention - like system consisted of 6.5 French guiding catheter and Y shaped connector. The feature of this system is that we can enhance adrenal vein with contrast agent from the guiding catheter while progressing the wire and micro-catheter. And, we performed S-AVS under guide of the biplane cine angiography. If we performed S-AVS only at frontal view of single plane cine angiography, we hardly find distinction of superior or lateral tributary vein. S-AVS revealed that isolated high plasma aldosterone concentration was detected in right superior tributary adrenal vein which probably flowed from adrenal mass.
At a later date, right partial adrenalectomy was conducted. Postoperatively, the blood pressure, aldosterone/renin ratio and result of captopril stress test changed as normalized.
Recently, three clinical trials revealed that renal sympathetic denervation (RDN) is effective for reducing the BP, suggesting that catheter intervention will become one of the options for the treatment of hypertension (HT). By screening for secondary HT at the introduction of RDN, cardiologists will encounter many PA patients in near future. Although the opportunity to do AVS will increase, many cardiologists tend to hesitate to do AVS because of its difficulty. However, AVS can be changed easily by using those above methods. Therefore, we report one case where S-AVS was performed by the above methods and partial adrenalectomy was effective.
The micro-wire and the micro catheter were advanced to the segmental adrenal vein using a percutaneous coronary intervention - like system consisted of 6.5 French guiding catheter and Y shaped connector. The feature of this system is that we can enhance adrenal vein with contrast agent from the guiding catheter while progressing the wire and micro-catheter. And, we performed S-AVS under guide of the biplane cine angiography. If we performed S-AVS only at frontal view of single plane cine angiography, we hardly find distinction of superior or lateral tributary vein. S-AVS revealed that isolated high plasma aldosterone concentration was detected in right superior tributary adrenal vein which probably flowed from adrenal mass.
At a later date, right partial adrenalectomy was conducted. Postoperatively, the blood pressure, aldosterone/renin ratio and result of captopril stress test changed as normalized.
Recently, three clinical trials revealed that renal sympathetic denervation (RDN) is effective for reducing the BP, suggesting that catheter intervention will become one of the options for the treatment of hypertension (HT). By screening for secondary HT at the introduction of RDN, cardiologists will encounter many PA patients in near future. Although the opportunity to do AVS will increase, many cardiologists tend to hesitate to do AVS because of its difficulty. However, AVS can be changed easily by using those above methods. Therefore, we report one case where S-AVS was performed by the above methods and partial adrenalectomy was effective.