Advertisement

Canadian Journal of Anaesthesia

, Volume 47, Issue 7, pp 647–652 | Cite as

Combined surgery for coronary artery disease and pheochromocytoma

  • Jean-Patrice Baillargeon
  • Bonavent Pek
  • Javier Teijeira
  • Jacques Poisson
  • Nicole van Rossum
  • Marie-France Langlois
Clinical Reports

Abstract

Purpose: To report a case of severe coronary artery disease complicating pheochromocytoma, managed with combined coronary artery bypass grafting (CABG) and adrenalectomy.

Clinical features: A 55-yr-old woman presented with poorly controlled hypertension and investigation revealed an active pheochromocytoma of her left adrenal gland. During medical preparation for adrenalectomy, she developed an acute myocardial infarct complicated with unstable angina. This required urgent CABG, and combined surgery for the triple vessels coronary artery disease and the pheochromocytoma was planned. We explain the details of medical preparation before surgery and the anesthetic considerations during the surgical procedure. Postoperative recovery was normal and no complication occurred. Even if the pheochromocytoma was malignant, her urinary catecholamines two months after the surgery were normal and remain normal after more than two years of follow-up.

Conclusion: We report a patient who underwent combined CABG and adrenalectomy for pheochromocytoma. The CABG was done first, followed by the adrenalectomy with invasive monitoring. The procedure was well tolerated with cure of the two underlying conditions. So we propose that combined procedure should be considered in this clinical setting.

Keywords

Coronary Artery Bypass Grafting Quinapril Severe Coronary Artery Disease Combine Surgery Phenoxybenzamine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif: Citer un cas de phéochromocytome compliqué d’une cardiopathie ischémique, traité par un pontage aortocoronarien combiné à une surrénalectomie.

Éléments cliniques: L’examen d’une femme de 55 ans souffrant d’hypertension difficilement contrôlée a révélé un phéochromocytome actif de la glande surrénale gauche. Pendant la préparation médicale à la surrénalectomie, elle a subi un infarctus myocardique aigu accompagné d’angine instable qui exigeait donc un pontage aortocoronarien d’urgence. On a alors planifié une intervention combinée pour les trois vaisseaux touchés par la cardiopathie ischémique et pour le phéochromocytome. Nous avons expliqué les détails de la préparation médicale avant l’opération et les aspects anesthésique de l’intervention. La récupération postopératoire a été normale et sans complication. Malgré un phéochromocytome malin, les catécholamines urinaires étaient normales deux mois après l’opération et sont demeurées telles après plus de deux ans de suivi.

Conclusion: Nous avons cité le cas d’une patiente qui a subi un pontage aortocoronarien combiné à une surrénalectomie pour l’ablation d’un phéochromocytome. Le pontage a été fait d’abord suivi par la surrénalectomie soutenue par un monitorage effractif. L’intervention, bien tolérée, a été suivie d’une guérison des deux conditions qui l’ont commandée. Nous suggérons que soit envisagée une intervention combinée dans ces circonstances.

References

  1. 1.
    Bravo EL. Evolving concepts in the pathophysiology, diagnosis, and treatment of pheochromocytoma. Endocr Rev 1994; 15: 356–68.PubMedCrossRefGoogle Scholar
  2. 2.
    Debache N, Bleinc D, Touboul A, Haquin G, Chouty F, Hardoux H. Pheochromocytoma and myocardial infarction. One case in a 34 years old man. (French) Rev Med Interne 1986; 7: 167–9.PubMedGoogle Scholar
  3. 3.
    St. John Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc 1981; 56: 354–60.Google Scholar
  4. 4.
    Brown P, Caplan RA. Recognition of an unsuspected pheochromocytoma during elective coronary bypass surgery. Can Anaesth Soc J 1986; 33: 785–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Dunn EJ, Wolff RK, Wright CB, Callard GM, Flege JB Jr. Presentation of undiagnosed pheochromocytoma during coronary artery bypass surgery. J Cardiovasc Surg 1989; 30: 284–7.Google Scholar
  6. 6.
    Fenje N, Lee LW, Jamieson WRE, Manning G Phaechromocytoma and mitral valve replacement. Can J Anaesth 1989; 36: 198–9.PubMedGoogle Scholar
  7. 7.
    Vacheron A, Heulin A, Baubion N, et al. Pheochromocytoma and coronary artery disease (two operations). Ann Med interne 1984; 135: 305–7.Google Scholar
  8. 8.
    Nielson DH, Tomasello DN, Brennan EJ Jr,Chen C Concomitant coronary artery bypass grafting and adrenalectomy for pheochromocytoma. J Card Surg 1995; 10: 179–83.PubMedCrossRefGoogle Scholar
  9. 9.
    Liem TH, Moll JE, Booij LHDJ. Thoracic epidural analgesia in a patient with bilateral phaeochromocytoma undergoing coronary artery bypass grafting. Anaesthesia 1991; 46: 654–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med 1986; 146: 2131–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Seah PW, Costa R, Wolfenden H. Combined Coronary artery bypass grafting and excision of adrenal pheochromocytoma. J Thorac Cardiovasc Surg 1995; 110: 559–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Roizen MF. Anesthetic implications of concurrent diseases.In: Miller RD (Ed.). Anesthesia, 5th ed. New-York: Churchill Livingstone Inc., 2000: 903.Google Scholar
  13. 13.
    Sheps SG, Jiang N-S, Klee GG, van Heerden JA Recent developments in the diagnosis and treatment of pheochromocytoma. Mayo Clin Proc 1990; 65: 88–95.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • Jean-Patrice Baillargeon
    • 1
  • Bonavent Pek
    • 2
  • Javier Teijeira
    • 3
  • Jacques Poisson
    • 3
  • Nicole van Rossum
    • 1
  • Marie-France Langlois
    • 1
  1. 1.From the Department of Medicine, Endocrine DivisionUniversité de sherbrooke, Centre Universitaire de Santé de l’EstrieSherbrookeCanada
  2. 2.Department of AnesthesiologyUniversité de Sherbrooke, Centre Universitaire de Santé de l’EstrieSherbrookeCanada
  3. 3.Department of SurgeryUniversité de Sherbrooke, Centre Universitaire de Santé de l’EstrieSherbrookeCanada

Personalised recommendations