The Experts below are selected from a list of 504 Experts worldwide ranked by ideXlab platform

William C. Little - One of the best experts on this subject based on the ideXlab platform.

  • Heart failure with a normal left ventricular ejection fraction: diastolic heart failure.
    Transactions of the American Clinical and Climatological Association, 2008
    Co-Authors: William C. Little
    Abstract:

    A reduced left ventricular ejection fraction measured by echocardiography in a patient with clinical features of heart failure demonstrates that the patient has a cardiac abnormality and that the clinical picture is, in fact, due to heart failure. As such, a reduced ejection fraction ( 0.50). Such patients are typically elderly women with systolic hypertension. These patients are subject to the sudden development of Pulmonary congestion (Flash Pulmonary Edema). The finding of heart failure in patients with a normal ejection fraction has focused attention on the role of diastolic dysfunction in producing symptomatic heart failure. The optimal treatment of patients with heart failure and normal ejection fraction has not yet been defined, but the control of systolic hypertension and the avoidance of fluid overload are important.

  • Flash Pulmonary Edema: association with hypertension and reoccurrence despite coronary revascularization.
    American heart journal, 2000
    Co-Authors: Keith Kramer, Paul M. Kirkman, Dalane W. Kitzman, William C. Little
    Abstract:

    Abstract Background The sudden development of acute (Flash) Pulmonary Edema may be an indication for coronary angiography and revascularization. However, the prevalence of coronary artery disease in these patients and the outcome after revascularization are not known. Methods and Results We evaluated 46 patients with an initial presentation of Flash Pulmonary Edema requiring hospitalization and obtained up to 3 years of follow-up in 45 patients. There were 22 men and 24 women, 44 to 84 years of age (67 ± 10 years, mean ± SD). Systolic blood pressure on admission was 194 ± 38 mm Hg. Twenty-four patients required intubation and mechanical ventilation. Left ventricular ejection fraction was >40% in 27 of 46 patients. Thirty-eight patients underwent coronary angiography; 33 had obstructive coronary artery disease. One other patient had regional wall motion abnormalities. Nineteen patients underwent coronary revascularization surgically and 8 percutaneously. Overall, Flash Pulmonary Edema reoccurred in one half of the patients. Of the 19 patients who underwent coronary revascularization, by 6 months there was 1 death and 9 patients had been hospitalized with recurrent Pulmonary Edema. Conclusions Many patients with Flash Pulmonary Edema have preserved systolic left ventricular function and coronary artery disease. Flash Pulmonary Edema frequently reoccurs in association with marked systolic hypertension, even after coronary revascularization. This suggests that control of hypertension is important and that coronary revascularization may not be adequate to prevent reoccurrence of Flash Pulmonary Edema. (Am Heart J 2000;140:451-5.)

Christopher J. White - One of the best experts on this subject based on the ideXlab platform.

  • Renal Artery Stenosis: When to Revascularize in 2017.
    Current problems in cardiology, 2017
    Co-Authors: Jose D. Tafur, Christopher J. White
    Abstract:

    Atherosclerotic renal artery stenosis is the leading cause of secondary hypertension; it can also cause progressive renal insufficiency and cardiovascular complications such as refractory heart failure and Flash Pulmonary Edema. Medical therapy including risk factor modification, renin-angiotensin-aldosterone system antagonists, lipid lowering agents, and antiplatelet therapy is the first line of treatment in all patients. Patients with uncontrolled renovascular hypertension despite optimal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have severe renal artery stenosis are likely to benefit from renal artery revascularization. Screening for renal artery stenosis can be done with Doppler ultrasonography, computed tomographic angiography and magnetic resonance angiography. Invasive physiologic measurements are useful to confirm the severity of renal hypoperfusion and therefore improve the selection patients likely to respond to renal artery revascularization. Primary patency exceeds 80% at 5 years and surveillance for in-stent restenosis can be done with periodic clinical, laboratory, and imaging follow-up.

  • Renal artery stenosis.
    Cardiology clinics, 2015
    Co-Authors: Jose D Tafur-soto, Christopher J. White
    Abstract:

    Atherosclerotic renal artery stenosis (RAS) is the single largest cause of secondary hypertension; it is associated with progressive renal insufficiency and causes cardiovascular complications such as refractory heart failure and Flash Pulmonary Edema. Medical therapy, including risk factor modification, renin-angiotensin-aldosterone system antagonists, lipid-lowering agents, and antiplatelet therapy, is advised in all patients. Patients with uncontrolled renovascular hypertension despite optimal medical therapy, ischemic nephropathy, and cardiac destabilization syndromes who have severe RAS are likely to benefit from renal artery revascularization. Screening for RAS can be done with Doppler ultrasonography, CT angiography, and magnetic resonance angiography.

  • Selecting patients likely to benefit from renal artery stenting
    Interventional Cardiology, 2014
    Co-Authors: Jose D Tafur-soto, Christopher J. White
    Abstract:

    Patients with refractory hypertension, progressive ischemic nephropathy and cardiac destabilization syndromes (e.g., Flash Pulmonary Edema) with obstructive atherosclerotic renal artery stenosis (RAS) are likely to benefit from renal artery stenting. Screening for RAS can be done with Doppler ultrasonography (DUS), computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). There is currently a disparity between the acute procedural success of renal artery stenting (97%) and the derived clinical benefit (∼70%), leading to debate about which candidates ultimately benefit from renal revascularization. Physiologic measurements such as hyperemic/resting translesional gradients are useful to confirm the severity of renal hypoperfusion and therefore improve the selection of patients likely to respond to renal artery revascularization. Experienced operators should perform renal interventions in order to minimize complications. Primary patency exceeds 80% at 5 years and surveillance for in-st...

  • catheter based therapy for atherosclerotic renal artery stenosis
    Progress in Cardiovascular Diseases, 2007
    Co-Authors: Christopher J. White
    Abstract:

    The prevalence of atherosclerotic renal artery stenosis (RAS) is more common than was previously thought, particularly in patients with known coronary, cerebrovascular, or peripheral vascular atherosclerosis. Clinical subsets in which RAS is more common include patients with uncontrolled hypertension, renal insufficiency, and/or sudden onset ("Flash") Pulmonary Edema. Renal artery atherosclerosis progresses over time and is associated with loss of renal function regardless of medical therapy. Patients with symptomatic (hypertension, renal insufficiency, or Flash Pulmonary Edema) and hemodynamically significant RAS are potential candidates for revascularization. The current standard of care is stent placement for aorto-ostial atherosclerotic lesions. Procedure success rates are very high (≥95%), with infrequent major complication rates. Five-year primary patency rates are 80% to 85%, and secondary patency rates exceed 90%. The key element in managing patients with RAS is selecting those most likely to benefit, that is, those with blood pressure control, preservation or improvement of renal function, and control of Flash Pulmonary Edema from renal revascularization. This article will highlight the anatomical features, physiologic parameters, and biomarkers that may be helpful in optimally selecting patients for renal artery revascularization.

  • Renal artery stent implantation in a patient with bilateral renal artery stenoses presenting with Flash Pulmonary Edema.
    International journal of cardiovascular interventions, 1998
    Co-Authors: Eduardo Núñez, Christopher J. White
    Abstract:

    We describe a patient with a clinical presentation of moderate renal dysfunction, recurrent hospitalizations for congestive heart failure, and an episode of abrupt-onset Pulmonary Edema (Flash Pulmonary Edema). Diagnostic angiography revealed triple-vessel coronary artery disease (CAD) and bilateral severe renal artery stenosis. This patient underwent successful bilateral renal artery stent implantation with marked improvement in his functional class without further recurrence of Pulmonary Edema.

Wei Chen - One of the best experts on this subject based on the ideXlab platform.

  • CKJ Review Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy
    2016
    Co-Authors: Wei Chen, Liise K Kayler, Renu Muttana, Victoria Chernyak, Martin S. Z, O. Deboccardo
    Abstract:

    Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion oc-curring in TRAS results in activation of the renin–angiotensin–aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash Pulmonary Edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syn-drome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic se-quelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of per-cutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention

  • Hypertension in Transplantation Ckj Review Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy
    2016
    Co-Authors: Wei Chen, Liise K Kayler, Renu Muttana, Victoria Chernyak, Martin S. Z, O. Deboccardo
    Abstract:

    Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion oc-curring in TRAS results in activation of the renin–angiotensin–aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash Pulmonary Edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syn-drome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic se-quelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of per-cutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention

  • transplant renal artery stenosis clinical manifestations diagnosis and therapy
    Ndt Plus, 2015
    Co-Authors: Wei Chen, Liise K Kayler, Martin S Zand, Renu Muttana, Victoria Chernyak, Graciela O Deboccardo
    Abstract:

    Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion occurring in TRAS results in activation of the renin–angiotensin–aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash Pulmonary Edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syndrome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic sequelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of percutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention.

Mitchell H. Goldman - One of the best experts on this subject based on the ideXlab platform.

  • Surgical management of Flash Pulmonary Edema secondary to renovascular hypertension
    American journal of surgery, 1997
    Co-Authors: David A. Weatherford, Michael B. Freeman, Rolland F. Regester, Paul F. Serrell, Scott L. Stevens, Mitchell H. Goldman
    Abstract:

    Background: Flask Pulmonary Edema (FPE) may be a manifestation of renovascular hypertension (RVHTN) and unresponsive to antihypertensive therapy. 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 despite a mean cardiac ejection fraction of 60%. Preoperative treatment was attempted for 12 days and included ventilatory support (n = 3) and hemodialysis (n = 2). Total decreased renal perfusion was demonstrated by arteriography and radionuclide scans, no patient having a functional, contralateral kidney. Renal revascularizations were not associated with mortalities; 1 patient experienced atalectasis requiring bronchoscopy. All patients were extubated within 48 hours of surgery. A significant reduction in blood pressure (BP, 46%) and serum creatinine (Cr, 53%, P ≤0.05) was observed. A mean of 1 antihypertensive medication was required at discharge compared with 3.4 on admission. At follow-up (mean 57 months) all patients remain cured of FPE. Conclusions: Medical management was unsuccessful in the treatment of FPE. Renal revascularization was associated with low morbidity and mortality, control of BP, restoration of renal function, and cure of FPE. These data suggest surgical intervention is the optimal mode of treatment of RVHTN associated with FPE.

Yoo-dong Won - One of the best experts on this subject based on the ideXlab platform.

  • Renal Artery Stenosis Presenting at Sudden Flash Pulmonary Edema in a Patient with Solitary Kidney
    The Korean Journal of Medicine, 2020
    Co-Authors: Jiyeon Choi, Young Ok Kim, Yoo-dong Won
    Abstract:

    Flash Pulmonary Edema is characterized by a sudden episode of dyspnea resulting from acute Pulmonary venous congestion, which resolves rapidly. We report a case of renal artery stenosis presenting as Flash Pulmonary Edema in a patient with solitary kidney treated by angioplasty with stent implantation. A 75-year-old man with solitary kidney visited the emergency room with acute shortness of breath. His blood pressure had risen to 206/90 mmHg and a chest radiograph revealed Pulmonary Edema. Echocardiography and coronary arteriography showed no clear abnormalities, but abdominal computed tomography revealed severe focal stenosis in the left proximal renal artery. A captopril renal scan found that the time to peak and half-time of radioactivity were delayed in the left kidney. Percutaneous transluminal angioplasty was performed, followed by stent implantation. After this procedure, the stenotic segment was completely dilated and blood pressure returned to the normal range.