Thorac Cardiovasc Surg 2006; 54(7): 498-499
DOI: 10.1055/s-2006-924096
Case Reports

© Georg Thieme Verlag KG Stuttgart · New York

Challenging the Advanced: Cardiac Surgery without Awareness of a Pheochromocytoma

T. Walker1 , D. H. L. Bail1 , E. Schmid2 , L. Haeberle2 , H. Kuehne2 , G. Ziemer1
  • 1Department of Thoracic, Cardiac and Vascular Surgery, Tübingen University, Tübingen, Germany
  • 2Department of Anesthesiology and Critical Care Medicine, Tübingen University, Tübingen, Germany
Further Information

Publication History

Received June 8, 2005

Publication Date:
06 November 2006 (online)

Abstract

We report the case of a 75-year-old male patient who underwent bypass surgery. Intraoperatively unstable hemodynamics with excessive arterial blood pressure was observed. This resulted in the tearing of an anastomosis, which subsequently required hemostasis for repeated bleeding. Postoperatively, laboratory findings and diagnostic imaging confirmed the diagnosis made intraoperatively of a pheochromocytoma. Any surgery without awareness of the possibility of a pheochromocytoma will dramatically increase intraoperative and postoperative morbidity and mortality, especially in cardiac surgery. The uncontrolled release of catecholamines raises arterial blood pressure which can become life-threatening and lead to serious intraoperative complications, as well as cerebrovascular and cardiac comorbidity.

References

  • 1 Sutton M G, Sheps S G, Lie J T. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series.  Mayo Clin Proc. 1981;  56 354-360
  • 2 Walther M M, Keiser H R, Linehan W M. Pheochromocytoma: evaluation, diagnosis, and treatment.  World J Urol. 1999;  17 35-39
  • 3 Baillargeon J P, Pek B, Teijeira J, Poisson J, van Rossum N, Langlois M F. Combined surgery for coronary artery disease and pheochromocytoma.  Can J Anaesth. 2000;  47 647-652
  • 4 Brown P, Caplan R A. Recognition of an unsuspected phaeochromocytoma during elective coronary artery bypass surgery.  Can Anaesth Soc J. 1986;  33 785-789
  • 5 Dunn E J, Wolff R K, Wright C B, Callard G M, Flege Jr J B. Presentation of undiagnosed pheochromocytoma during coronary artery bypass surgery.  J Cardiovasc Surg. 1989;  30 284-287
  • 6 Bready L L, Hoff B H, Lamm D L, Dyer M. Perioperative management in undiagnosed pheochromocytoma.  Urology. 1983;  21 505-507
  • 7 Seah P W, Costa R, Wolfenden H. Combined coronary artery bypass grafting and excision of adrenal pheochromocytoma.  J Thorac Cardiovasc Surg. 1995;  110 559-560
  • 8 James T N. De subitaneis mortibus. XIX. On the cause of sudden death in pheochromocytoma, with special reference to the pulmonary arteries, the cardiac conduction system, and the aggregation of platelets.  Circul. 1976;  54 348-356

M.D. Tobias Walker

Department of Thoracic, Cardiac and Vascular Surgery
Tübingen University

Hoppe-Seyler-Straße 3

72076 Tübingen

Germany

Phone: + 49 7 07 12 98 66 11

Fax: + 49 70 71 29 59 64

Email: tobias.walker@med.uni-tuebingen.de