STATE OF THE ART ARTICLE
A 27-year retrospective single-center experience
Hitesh Agrawal MD
Douglas Moodie MD
Athar M. Qureshi MD
Alisa A. Acosta MD
Jose A. Hernandez MD
Michael C. Braun MD
Henri Justino MD
Department of Pediatrics, Texas Children’s
Hospital and Baylor College of Medicine,
Lillie Frank Abercrombie Section of
Cardiology, Houston, Texas
Texas Children’s Hospital and Baylor
College of Medicine, C. E. Mullins Cardiac
Catheterization Laboratories, Houston,
Renal Section, Department of Pediatrics,
Texas Children’s Hospital and Baylor College
of Medicine, Houston, Texas
Interventional Radiology Section, Pediatric
Radiology, Texas Children’s Hospital and
Baylor College of Medicine, Houston, Texas
Henri Justino, MD, Texas Children’s
Hospital, 6621 Fannin St., MC 19345-C,
Houston, TX 77030.
Background: Renovascular hypertension (RVH) can be caused by renal artery stenosis (RAS) and/
or middle aortic syndrome (MAS).
Methods: Patients who received surgical or transcatheter treatment for RVH between 1/1991
and 11/2017 were retrospectively reviewed using age 5 adjusted blood pressure ratio (BPR).
Results: Fifty-three patients diagnosed with RVH at a median age of 4.5 (0–18) years were
included. Vascular involvement ranged from MAS with RAS (20), RAS only (32), and MAS only (1).
The first intervention was transcatheter in 47 patients (transcatheter group: angioplasty 5 41, sten-
ting 5 5, and thrombectomy 5 1), and surgical in 6 patients (surgical group), occurring at a median
age of 6.2 (0.1–19.6) years. There was a change toward transcatheter interventions as the first
procedure over the study period. First reinterventions in the transcatheter group (27 lesions in 18
patients) were repeat transcatheter (in 20 lesions) and surgery (7 lesions) at a median of 92 (2–
2555) days; in the surgical group (5 lesions in 4 patients) first reinterventions were transcatheter (4
lesions) and repeat surgery (1) at a median of 2.2 (1.1–12.0) years. A total of 136 transcatheter and
30 surgical discrete interventions were performed. There was a significant decline in antihyperten-
sive medications and BPR at 4–6 months after the first intervention and on last follow-up in
patients initially treated by transcatheter means while the decline was not significant in the surgical
group (limited by small sample size). Complications were significantly more common in the surgical
group (P < .01), 11/27 (41%) vs 10/136 (7.4%). Four patients died (2 from each group): 2 with con-
genital renal artery atresia and MAS, 2 with MAS and RAS. The median follow-up interval was 3.6
Conclusion: Pediatric patients with RVH treated with transcatheter means as the first intervention
had significant improvement in BPR, as well as decline in antihypertensive medications and were
less likely to suffer major complications.
midaortic syndrome, middle aortic syndrome, renal artery stenosis, renovascular hypertension
This paper was presented in a poster format at the Society for Cardiovascular Angiography and Interventions, Orlando, FL, USA, May 2016.
Congenital Heart Disease. 2018;13:349–356. wileyonlinelibrary.com/journal/chd
2018 Wiley Periodicals, Inc.
Received: 6 March 2018
Accepted: 16 March 2018