Phaeochromocytoma and mitral valve replacement

Combined coronary artery bypass grafting and phaeochromocytoma excision

We 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.

Combined surgery for coronary artery disease and pheochromocytoma

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.

Concomitant coronary artery bypass grafting and adrenalectomy for pheochromocytoma

We report the first case of concomitant coronary artery bypass grafting (CABG) and adrenalectomy for pheochromocytoma. Which lesion to correct first and staging of the corrective procedures are highly controversial issues. Issues concerning pre- and intraoperative control of hemodynamic instability from catecholamine release are discussed. Preoperative alpha and beta blockade permitted excellent hemodynamic control in the operating room. Operative and postoperative courses were uneventful and the patient had complete resolution of his angina and hypertension. We conclude that concomitant CABG and adrenalectomy is the preferred approach when pheochromocytoma and symptomatic coronary artery atherosclerosis coexist.