SURGICAL-MANAGEMENT OF FLASH PULMONARY-EDEMA SECONDARY TO RENOVASCULAR HYPERTENSION

BACKGROUND: Flask pulmonary edema (FPE) may be a manifestation of reno vascular hypertension (RVHTN) and unresponsive to antihypertensive the rapy. METHODS: Response to antihypertensive therapy and perioperative outcomes were determined in 5 consecutive patients with FPE. RESULTS: A mean of 2.3 admissions for the treatment of FPE were observed despit e a mean cardiac ejection fraction of 60%. Preoperative treatment was attempted for 12 days and included ventilatory support (n = 3) and hem odialysis (0 = 2). Total decreased renal perfusion was demonstrated by arteriography and radionuclide scans, no patient having a functional, contralateral kidney. Renal revascularizations were not associated wi th mortalities; 1 patient experienced atalectasis requiring bronchosco py. All patients were extubated within 48 hours of surgery, A signific ant reduction in blood pressure (BP, 46%) and serum creatinine (Cr, 53 %, P less than or equal to 0.05) was observed. A mean of 1 antihyperte nsive medication was required at discharge compared with 3.4 on admiss ion, At follow-up (mean 57 months) all patients remain cured of FPE. C ONCLUSIONS: Medical management was unsuccessful in the treatment of FP E, Renal revascularization was associated with low morbidity and morta lity, control of BP, restoration of renal function, and cure of FPE, T hese data suggest surgical intervention is the optimal mode of treatme nt of RVHTN associated with FPE. (C) 1997 by Excerpta Medica, Inc.