[MP-15] A case of improvement of uncontrollable heart failure treated by a combination of the
renal and coronary artery angioplasty in a patient with unstable angina
Background: Cardiac diseases such as heart failure and unstable angina are sometimes caused by renal stenosis. However, symptoms associated with renal artery stenosis (RAS) are often obscure in a clinical setting.
Case: An 83-year-old woman had general fatigue and edema more than 2 months ago, she was treated with a diuretic drug but was not improved. She had a history of hypertension, hypercholesterolemia, and receiving percutaneous coronary intervention (PCI) for angina pectoris and bilateral angioplasty for iliac artery stenosis. She was admitted to our hospital complaining of chest pain and productive cough. Her serum creatinine level was 1.29mg/dl on admission. Both her RAs were severely calcified, and the left kidney was atrophied on computed tomography images before her admission. Doppler ultrasonography revealed severe stenosis of right RA (Peak systolic verbosity: 3.1m/s and renal aortic ratio: 7.3). Invasive coronary and renal angiography was performed and it documented 90% narrowing at the proximal left anterior descending artery (LAD), and furthermore, her renal angiogram showed 99% stenosis of the right RA with calcification, and total occlusion of the left RA. Therefore, first, we performed PCI of the proximal LAD. Her chest pain was improved, but generalized edema was not improved. After three days of PCI, we performed percutaneous transluminal renal angioplasty of the right RA. A balloon-expandable renal stent was implanted. On the day of the procedure, her urine volume was dramatically increased. After the procedure, her generalized edema and serum creatinine level were improved (0.88mg/dl) with no change of her blood pressure.
Conclusion: It might be necessary to consider that RAS is the cause of heart failure in patients with multiple risk factors of arteriosclerosis.
Case: An 83-year-old woman had general fatigue and edema more than 2 months ago, she was treated with a diuretic drug but was not improved. She had a history of hypertension, hypercholesterolemia, and receiving percutaneous coronary intervention (PCI) for angina pectoris and bilateral angioplasty for iliac artery stenosis. She was admitted to our hospital complaining of chest pain and productive cough. Her serum creatinine level was 1.29mg/dl on admission. Both her RAs were severely calcified, and the left kidney was atrophied on computed tomography images before her admission. Doppler ultrasonography revealed severe stenosis of right RA (Peak systolic verbosity: 3.1m/s and renal aortic ratio: 7.3). Invasive coronary and renal angiography was performed and it documented 90% narrowing at the proximal left anterior descending artery (LAD), and furthermore, her renal angiogram showed 99% stenosis of the right RA with calcification, and total occlusion of the left RA. Therefore, first, we performed PCI of the proximal LAD. Her chest pain was improved, but generalized edema was not improved. After three days of PCI, we performed percutaneous transluminal renal angioplasty of the right RA. A balloon-expandable renal stent was implanted. On the day of the procedure, her urine volume was dramatically increased. After the procedure, her generalized edema and serum creatinine level were improved (0.88mg/dl) with no change of her blood pressure.
Conclusion: It might be necessary to consider that RAS is the cause of heart failure in patients with multiple risk factors of arteriosclerosis.