Blood Pressure Changes in Essential Hypertension after Excision of the Celiac Ganglion and Denervation of the Aortic Plexus

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One of the first operations designed to control elevation of blood pressure in essential hypertension was a unilateral adrenalectomy which was performed by Dr. George Crile in 1915. Since that time, 120 operations designed to control essential hypertension have been performed at the Cleveland Clinic.

A series of eleven unilateral adrenalectomies resulted in only transitory falls of blood pressure levels. Bilateral denervation of the adrenal glands was next attempted, and this procedure resulted in definite symptomatic relief.

In the majority of cases the hypertension was temporarily lessened, and in early cases in young patients lasting relief was obtained. In advanced cases, however, no striking changes in blood pressure were noted. This operation alone is, therefore, not a specific treatment for essential hypertension.

This experience with operations on the adrenal glands led us to abandon the hypothesis that essential hypertension was a disorder resulting from an excessive secretion of adrenalin and forced us to look for other explanations. Working on the hypothesis that the increased peripheral resistance necessary to maintain the hypertension was the result of a spasm of the vascular bed and was mediated by the sympathetic nervous system, Dr. George Crile on May 4, 1934 in addition to the denervation of the adrenal sectioned the left major splanchnic nerve beneath the diaphragm. The operation was performed through a modified kidney incision and was followed by an immediate fall in blood pressure. In the next series of cases the major, minor, and least splanchnic nerves were divided through a subdiaphragmatic. . .



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