Excision of adrenal pheochromocytoma and coronary artery bypass graft surgery with cardiopulmonary bypass

Balabaud-Pichon, V; Bopp, P; Lévy, François; Thiranos, J.-C.; Steib, A.

doi:10.1053/jcan.2002.124145

Cited by 12 publications

(7 citation statements)

References 10 publications

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“…The risk of this approach relates to anticoagulation required for bypass and its effects when performing adrenal resection. For this reason some reports have encouraged CABG surgery without using cardiopulmonary bypass with favorable outcomes . Staged CABG followed by adrenalectomy 4‐6 weeks later was reported with favorable outcomes in two cases .…”

Section: Discussionmentioning

confidence: 99%

Phaeochromocytoma presenting with labile blood pressures following coronary artery bypass grafting

et al. 2016

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Pheochromocytomas have been reported prior to and during coronary artery bypass surgery. We present a patient with an undiagnosed pheochromocytoma who presented with labile hypertension following coronary artery bypass surgery. This case calls attention to the inclusion of an undiagnosed pheochromocytoma in the differential diagnosis for all patients who develop labile hypertension in the postoperative period following cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Phaeochromocytoma presenting with labile blood pressures following coronary artery bypass grafting

et al. 2016

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“…A few cases in the literature have described the hemodynamic challenges of performing CABG in a patient undergoing pheochromocytoma resection concurrently . To our knowledge, however, no reports exist of a patient surviving surgical coronary revascularization with metastatic pheochromocytoma.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to reducing catecholamine production with metyrosine, we believe the preoperative administration of phenoxybenzamine, an irreversible alpha receptor blocker, helped in the care of our patient to minimize the severity of intraoperative blood pressure fluctuation. Phenoxybenzamine is likely more safe and effective for preoperative blood pressure control for a patient with pheochromocytoma undergoing CABG, as compared to calcium channel blocker therapy such as nicardipine …”

Section: Discussionmentioning

confidence: 99%

Coronary Bypass Surgery in the Presence of Metastatic Pheochromocytoma

2015

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The hemodynamic management of a patient with a pheochromocytoma presents special challenges due to the episodic release of catecholamines from the tumor, which threatens to provoke a hypertensive crisis. We present a patient with metastatic pheochromocytoma (bone, lung, lymph nodes) who underwent successful coronary artery bypass graft (CABG) surgery following premedication with phenoxybenzamine and metyrosine as well as the use of intraoperative phentolamine for the management of

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“…Our patients were stabilised for 6-8 weeks prior to surgery, largely because they were referred from secondary centres, where treatment with phenoxybenzamine had been initiated. In other series, patients have received alpha-blockers for 10-21 days prior to surgery [19][20][21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Six cases of combined CABG followed by open adrenalectomy have been reported in the literature [19-22, 24, 26]. Five patients had good outcomes and one case was complicated by haemorrhage and subsequent death [20]. This case was notable in that phenoxybenzamine was not used pre-operatively and CPB was continued during the adrenelectomy with full heparin anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Combined coronary artery bypass grafting and phaeochromocytoma excision

To¹,

Frost²,

Grey³

et al. 2007

Anaesthesia

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SummaryWe report two patients who had successful combined coronary artery bypass grafting and excision of phaeochromocytoma. These cases represent the first reports of combined coronary artery bypass grafting and laparoscopic adrenalectomy for phaeochromocytoma and of combined coronary artery bypass grafting and excision of extra-adrenal phaeochromocytoma. With careful peri-and intra-operative management, especially in regard to haemostasis, combined operations for coronary artery disease and phaeochromocytoma are both feasible and safe. Phaeochromocytoma requires careful pre-and intraoperative control of blood pressure to prevent vascular instability induced by unpredictable catecholamine release. It is associated with important risk factors for ischaemic heart disease, such as hypertension, glucose intolerance, hypercholesterolaemia and enhanced coagulation [1], which contribute to the accelerated development of atherosclerosis [2]. Patients with co-existent phaeochromocytoma and coronary artery disease requiring surgical revascularisation are rare, but pose a significant management problem for physicians, surgeons and anaesthetists, in particular with respect to the timing of coronary artery bypass grafting (CABG) and adrenalectomy. We report two cases of phaeochromocytoma with severe coronary artery disease diagnosed during the pre-operative work-up for phaeochromocytoma excision. Both patients were managed successfully with combined CABG and tumour excision, in the first case by laparoscopic adrenalectomy and in the second by laparotomy for a retroperitoneal paraganglioma. Case report 1A 76-year-old female non-smoker with a history of hypercholesterolaemia, hypothyroidism and autoimmune haemolytic anaemia, presented with episodic diaphoresis and nausea for 2 years, worse over the preceding 5 months. She had mild angina and a progressive reduction in exercise tolerance to one flight of stairs, but denied palpitations or symptoms of heart failure. The differential diagnosis included phaeochromocytoma and the patient underwent computed tomography (CT) of the abdomen, where a 4-cm right adrenal mass was found and confirmed to be a phaeochromocytoma by urinary catecholamine assays (adrenaline 1.57 mmol.day )1 (< 0.10), noradrenaline 1.85 lmol.day )1 (< 0.76)). Treatment with phenoxybenzamine was commenced. In view of her cardiac symptoms, she underwent an exercise ECG which was positive and coronary angiography demonstrated severe three vessel disease with normal left ventricular function. Six weeks after the initial diagnosis she proceeded to surgery. At this time she was receiving total daily doses of phenoxybenzamine 120 mg, metoprolol succinate 47.5 mg, simvastatin 40 mg and aspirin 100 mg. Her pre-operative blood pressure was 140 ⁄ 72 mmHg lying and 130 ⁄ 64 mmHg standing, with a heart rate of 65 beats.min )1. After premedication with oral midazolam and radial arterial line insertion, anaesthesia was induced with fentanyl and etomidate, and tracheal intubation was facilitated with rocuronium. Anaesthesia wa...

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Excision of adrenal pheochromocytoma and coronary artery bypass graft surgery with cardiopulmonary bypass

Cited by 12 publications

References 10 publications

Phaeochromocytoma presenting with labile blood pressures following coronary artery bypass grafting

Phaeochromocytoma presenting with labile blood pressures following coronary artery bypass grafting

Coronary Bypass Surgery in the Presence of Metastatic Pheochromocytoma

Combined coronary artery bypass grafting and phaeochromocytoma excision

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