[Methods of plastic surgery of the renal arteries in children with vasorenal hypertension].

The work deals with the management of vasorenal hypertension in children and adolescents. The Bakulev Institute of Cardiovascular Surgery had 185 children with arterial hypertension from 1965 to 1990. Their ages ranged from 12 months to 17 years. The vasorenal genesis of hypertension was caused by fibromuscular dysplasia (FMD) of the renal arteries in 61 patients, unspecific aortoarteritis (UAA) in 39, hypoplasia of the abdominal aorta, kidneys, and renal arteries in 22 patients, supernumerary renal arteries were found in 7 patients. A total of 119 operations were carried out on 106 patients. Operations and one-stage revascularization of the kidneys and alimentary organs were performed on 22 patients, isolated reconstruction of the renal arteries on 51 patients. Among 99 patients with stenoses and aneurysms of the renal arteries 13 were treated by nephrectomy (11.3%). The postoperative mortality was 0.9%. A hypotensive effect was not produced in the immediate postoperative period in 5 patients with UAA (4.6%) and in one patient with, FMD (0.9%). Six operations were performed in late-term periods after the first operative interventions: 2 for aneurysm of autovenous grafts, 2 for restenosis of the renal arteries, and 2 for stenosis of the aorta distal to the primary site of reconstruction in UAA. Three patients died in the late-term periods. The stability of good operative results was highest in congenital hypoplasia of the aorta--100%. A favorable effect of the operation persists in 89.6% of patients with FMD of the renal arteries. The stability of the effect is lowest (75%) in UAA.