1
|
Tanaka Y, Sumie M, Hashimoto T, Osawa S, Karashima Y, Kandabashi T, Yamaura K. Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series. JA Clin Rep 2023; 9:13. [PMID: 36897467 PMCID: PMC10006357 DOI: 10.1186/s40981-023-00605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. CASE PRESENTATION We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. CONCLUSIONS Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.
Collapse
Affiliation(s)
- Yuto Tanaka
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.,Department of Anesthesia, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuo-Ku, Fukuoka, 810-0001, Japan
| | - Makoto Sumie
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. .,Department of Anesthesia, St. Mary's Hospital, 422 Tsubukuhonmachi, Kurume, Fukuoka, 830-8543, Japan.
| | - Takuma Hashimoto
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Sayaka Osawa
- Department of Critical Care, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuji Karashima
- Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tadashi Kandabashi
- Medical Information Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
2
|
Kim TH, Yang HK, Jang HJ, Yoo SJ, Khalili K, Kim TK. Abdominal imaging findings in adult patients with Fontan circulation. Insights Imaging 2018; 9:357-367. [PMID: 29623675 PMCID: PMC5991003 DOI: 10.1007/s13244-018-0609-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022] Open
Abstract
Abstract The Fontan procedures, designed to treat paediatric patients with functional single ventricles, have markedly improved the patient’s survival into adulthood. The physiology of the Fontan circuit inevitably increases systemic venous pressure, which may lead to multi-system organ failure in the long-term follow-up. Fontan-associated liver disease (FALD) can progress to liver cirrhosis with signs of portal hypertension. Focal nodular hyperplasia-like nodules commonly develop in FALD. Imaging surveillance is often performed to monitor the progression of FALD and to detect hepatocellular carcinoma, which infrequently develops in FALD. Other abdominal abnormalities in post-Fontan patients include protein losing enteropathy and pheochromocytoma/paraganglioma. Given that these abdominal abnormalities are critical for patient management, it is important for radiologists to become familiar with the abdominal abnormalities that are common in post-Fontan patients on cross-sectional imaging. Teaching points • Fontan procedure for functional single ventricle has improved patient survival into adulthood. • Radiologists should be familiar with unique imaging findings of Fontan-associated liver disease. • Focal nodular hyperplasia-like nodules commonly develop in Fontan-associated liver disease. • Hepatocellular carcinoma, protein-losing enteropathy, pheochromocytoma/paraganglioma may develop. Electronic supplementary material The online version of this article (10.1007/s13244-018-0609-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongnogu, Seoul, 03080, South Korea
| | - Hyun Kyung Yang
- Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Hyun-Jung Jang
- Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Shi-Joon Yoo
- Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5J2L4, Canada
| | - Korosh Khalili
- Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada
| | - Tae Kyoung Kim
- Department of Medical Imaging, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| |
Collapse
|
3
|
Suffredini G, Diaz-Rodriguez N, Chakravarthy K, Mathur A, Hayanga HK, Frank SM, Ringel RE, Freiberg S, Barodka VM, Steppan J. Anesthetic Management of Pheochromocytoma Resection in Adults with Single Ventricle Physiology. Cureus 2017; 9:e1928. [PMID: 29464136 PMCID: PMC5806932 DOI: 10.7759/cureus.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Survival rates for patients with palliated congenital heart disease are increasing, and an increasing number of adults with cyanotic congenital heart disease (CCHD) might require surgical resection of pheochromocytoma-paraganglioma (PHEO-PGL). A recent study supports the idea that patients with a history of CCHD and current or historical cyanosis might be at increased risk for developing PHEO-PGL. We review the anesthetic management of two adults with single-ventricle physiology following Fontan palliation presenting for PHEO-PGL resection and review prior published case reports. We found the use of epidural analgesia to be safe and effective in the operative and postoperative management of our patients.
Collapse
Affiliation(s)
- Giancarlo Suffredini
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | | | - Krishnan Chakravarthy
- Department of Anesthesia, Critical Care and Pain Medicine, University of California, San Diego
| | - Aarti Mathur
- Surgery, The Johns Hopkins University School of Medicine
| | - Heather K Hayanga
- Department of Anesthesiology, West Virginia University School of Medicine
| | - Steve M Frank
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | | | - Stephen Freiberg
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Viachaslau M Barodka
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| | - Jochen Steppan
- Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine
| |
Collapse
|
4
|
Yan Z, Shang Y, Li F, Xie F, Qian H, Zhang Y, Yue B. Therapeutic efficacy of phentolamine in the management of severe hand, foot and mouth disease combined with pulmonary edema. Exp Ther Med 2017; 13:1403-1407. [PMID: 28413485 PMCID: PMC5377404 DOI: 10.3892/etm.2017.4104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/18/2016] [Indexed: 01/28/2023] Open
Abstract
The aim of this study was to examine the effects of phentolamine on severe hand, foot and mouth disease (HFMD) combined with pulmonary edema (PE). From May 2008 to December 2012, 53 children with severe HFMD plus PE were enrolled in the treatment group, receiving phentolamine intravenously at a loading dose of 5 µg/kg/min. The control group comprised 52 children with the same disease who did not receive phentolamine infusion. Data concerning creatine kinase (CK), CK-MB, cardiac troponin I (cTnI), heart rate, systolic blood pressure (SBP) and the duration of ventilation dependence and hospitalization were collected. Adverse events were also recorded. It was found that the phentolamine-treated patients exhibited significantly lower CK, CK-MB and cTnI levels, heart rate and SBP than the controls (P<0.01 for all parameters). The average duration of ventilator dependence and hospitalization was significantly shorter (P<0.01) in the phentolamine group than in the control group. It was also found that the overall mortality rate was lower in the phentolamine group (5.8%) than in the control group (11.5%). No adverse events were observed in either group. Thus, these results offer preliminary evidence that phentolamine reduces mortality and relieves the symptoms of EV71-induced PE. Phentolamine is a potential therapeutic agent for this highly lethal disorder.
Collapse
Affiliation(s)
- Zhixin Yan
- Department of First Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Yaokai Shang
- Department of Pediatrics, Yanshan Fude Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Fengxian Li
- Department of Internal Medicine, Yanshan Fude Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Fei Xie
- Department of First Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Huili Qian
- Department of Second Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Youqi Zhang
- Department of Fourth Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| | - Bin Yue
- Department of First Pediatric Internal Medicine, Cangzhou Central Hospital, Cangzhou, Hebei 061000, P.R. China
| |
Collapse
|
5
|
Kasaliwal R, Sarathi V, Pandit R, Budyal SR, Bukan A, Kakade H, Jagtap VS, Lila AR, Bandgar T, Menon PS, Shah NS. Pheochromocytoma and tetralogy of Fallot: a rare but potentially dangerous combination. Endocr Pract 2016; 20:e80-5. [PMID: 24449673 DOI: 10.4158/ep13408.cr] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a case of pheochromocytoma (PHEO) with tetralogy of Fallot (TOF) and discuss the difficulties encountered during the management of this patient, with a review of the literature. METHODS We report the clinical course, imaging, and management issues of our patient and review relevant literature. RESULTS A 14-year-old female who was known to have TOF presented with classical paroxysmal symptoms and worsening dyspnea. She was diagnosed as having epinephrine-secreting PHEO based on biochemical, radiologic, and functional imaging. She was treated with an α-1 blocker for control of paroxysms but developed severe cyanotic spells. She required addition of a calcium-channel blocker for control of the paroxysms and underwent successful cardiac repair. CONCLUSION Treatment of the combination of cyanotic congenital heart disease (CCHD) and PHEO requires an individualized and multidisciplinary approach with judicious use of available medications. This is the first case of uncorrected TOF and epinephrine-secreting PHEO. Our case also reiterates the need for further studies to better understand the pathophysiologic link between PHEO/paraganglioma and CCHD.
Collapse
Affiliation(s)
- Rajeev Kasaliwal
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Vijaya Sarathi
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Reshma Pandit
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Sweta R Budyal
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Amol Bukan
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Harshal Kakade
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Varsha S Jagtap
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Anurag R Lila
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Padmavathy S Menon
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| | - Nalini S Shah
- Department of Endocrinology, Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
| |
Collapse
|
6
|
Yamamoto K, Namba N, Kubota T, Usui T, Takahashi K, Kitaoka T, Fujiwara M, Hori Y, Kogaki S, Oue T, Morii E, Ozono K. Pheochromocytoma complicated by cyanotic congenital heart disease: a case report. Clin Pediatr Endocrinol 2016; 25:59-65. [PMID: 27212797 PMCID: PMC4860516 DOI: 10.1297/cpe.25.59] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/16/2016] [Indexed: 11/04/2022] Open
Abstract
Coincidental cyanotic congenital heart disease and pheochromocytoma is uncommon, although some cases have been reported. We describe a girl aged 15 yr and 11 mo with pheochromocytoma and tricuspid atresia treated by performing the Fontan surgery. The patient did not have any specific symptoms of syndrome related to pheochromoytoma or a family history of pheochromocytoma. During cardiac catheterization, her blood pressure increased markedly, and an α-blocker was administered. Catecholamine hypersecretion was observed in the blood and urine, and abdominal computed tomography revealed a tumor in the right adrenal gland. Scintigraphy showed marked accumulation of (123)I-metaiodobenzylguanidine in the tumor, which led to a diagnosis of pheochromocytoma. We did not detect any germline mutations in the RET, VHL, SDHB, SDHD, TMEM127, or MAX genes. This patient had experienced mild systemic hypoxia since birth, which may have contributed to the development of pheochromocytoma.
Collapse
Affiliation(s)
- Keiko Yamamoto
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyuki Namba
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Pediatrics, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Usui
- Clinical Research Institute, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Kunihiko Takahashi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Fujiwara
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigetoyo Kogaki
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
7
|
Erdoğan MA, Uçar M, Özkan AS, Özgül Ü, Durmuş M. Perioperative Management of Severe Hypertension during Laparoscopic Surgery for Pheochromocytoma. Turk J Anaesthesiol Reanim 2016; 44:47-9. [PMID: 27366556 DOI: 10.5152/tjar.2016.25993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022] Open
Abstract
Phaeochromocytoma is a catecholamine-secreting vascular tumour that is derived from chromaffin cell. Lethal cardiovascular complications, such as serious hypertension, myocardial infarction and aortic dissection, may occur because of uncontrolled catecholamine release. Each stage of anaesthesia management has vital importance because of this destructive catecholamine secretion that may occur during induction, perioperative stage and surgical manipulation. In this study, we report regarding the preoperative preparation and severe, persistent hypertension attack management with a combination of α-adrenergic blockade, β-adrenergic blockade, sodium nitroprusside and remifentanil in a patient who underwent laparoscopic surgery for phaeochromocytoma.
Collapse
Affiliation(s)
- Mehmet Ali Erdoğan
- Department of Anaesthesiology and Reanimation, İnönü University School of Medicine, Turgut Özal Medical Center, Malatya, Turkey
| | - Muharrem Uçar
- Department of Anaesthesiology and Reanimation, İnönü University School of Medicine, Turgut Özal Medical Center, Malatya, Turkey
| | - Ahmet Selim Özkan
- Department of Anaesthesiology and Reanimation, İnönü University School of Medicine, Turgut Özal Medical Center, Malatya, Turkey
| | - Ülkü Özgül
- Department of Anaesthesiology and Reanimation, İnönü University School of Medicine, Turgut Özal Medical Center, Malatya, Turkey
| | - Mahmut Durmuş
- Department of Anaesthesiology and Reanimation, İnönü University School of Medicine, Turgut Özal Medical Center, Malatya, Turkey
| |
Collapse
|
8
|
Opotowsky AR, Moko LE, Ginns J, Rosenbaum M, Greutmann M, Aboulhosn J, Hageman A, Kim Y, Deng LX, Grewal J, Zaidi AN, Almansoori G, Oechslin E, Earing M, Landzberg MJ, Singh MN, Wu F, Vaidya A. Pheochromocytoma and paraganglioma in cyanotic congenital heart disease. J Clin Endocrinol Metab 2015; 100:1325-34. [PMID: 25581599 PMCID: PMC4399286 DOI: 10.1210/jc.2014-3863] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Aberrant cellular oxygen sensing is a leading theory for development of pheochromocytoma (PHEO) and paraganglioma (PGL). OBJECTIVE The objective of the study was to test the hypothesis that chronic hypoxia in patients with cyanotic congenital heart disease (CCHD) increases the risk for PHEO-PGL. DESIGN/SETTING/PARTICIPANTS We investigated the association between CCHD and PHEO-PGL with two complementary studies: study 1) an international consortium was established to identify congenital heart disease (CHD) patients with a PHEO-PGL diagnosis confirmed by pathology or biochemistry and imaging; study 2) the 2000-2009 Nationwide Inpatient Survey, a nationally representative discharge database, was used to determine population-based cross-sectional PHEO-PGL frequency in hospitalized CCHD patients compared with noncyanotic CHD and those without CHD using multivariable logistic regression adjusted for age, sex, and genetic PHEO-PGL syndromes. RESULTS In study 1, we identified 20 PHEO-PGL cases, of which 18 had CCHD. Most presented with cardiovascular or psychiatric symptoms. Median cyanosis duration for the CCHD PHEO-PGL cases was 20 years (range 1-57 y). Cases were young at diagnosis (median 31.5 y, range 15-57 y) and 7 of 18 had multiple tumors (two bilateral PHEO; six multifocal or recurrent PGL), whereas 11 had single tumors (seven PHEO; four PGL). PGLs were abdominal (13 of 17) or head/neck (4 of 17). Cases displayed a noradrenergic biochemical phenotype similar to reported hypoxia-related PHEO-PGL genetic syndromes but without clinical signs of such syndromes. In study 2, hospitalized CCHD patients had an increased likelihood of PHEO-PGL (adjusted odds ratio 6.0, 95% confidence interval 2.6-13.7, P < .0001) compared with those without CHD; patients with noncyanotic CHD had no increased risk (odds ratio 0.9, P = .48). CONCLUSIONS There is a strong link between CCHD and PHEO-PGL. Whether these rare diseases coassociate due to hypoxic stress, common genetic or developmental factors, or some combination requires further investigation.
Collapse
Affiliation(s)
- Alexander R Opotowsky
- Department of Cardiology (A.R.O., L.E.M., M.J.L., M.N.S., F.W.), Boston Children's Hospital, Boston, Massachusetts 02115; Division of Cardiovascular Medicine, (A.R.O., M.J.L., M.N.S., F.W.), Division of Endocrinology (A.V.), Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115; Department of Medicine (J.Gi., M.R.), Columbia University Medical Center, New York, New York 10027; Adult Congenital Heart Disease Program (M.G.), University Hospital Zurich, CH-8032 Zurich, Switzerland; Department of Medicine (J.A.,A.H.), Division of Cardiology, University of California, Los Angeles, Medical Center, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California 90095; Department of Cardiology (Y.K., L.X.D.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; Department of Medicine (Y.K., L.X.D.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104; Division of Cardiology (J.Gr.), St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada V5Z 4H4; The Heart Center (A.N.Z.), Nationwide Children's Hospital, Columbus, Ohio 43205; Department of Internal Medicine (A.N.Z.), The Ohio State University Wexner Medical Center, Columbus, Ohio 43210; Department of Medicine (G.A., E.O.), University Health Network and University of Toronto, Toronto, Ontario, CanadaM5G2C4; Department of Pediatrics (M.E.), Medical College of Wisconsin, Milwaukee, Wisconsin 53226; Center for Adrenal Disorders (A.V.), Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Lee HC, Nam K, Lee JH, Park YH, Kim HS, Kim CS, Kim JT. Anesthetic management of laparoscopic pheochromocytoma excision in a patient with a Fontan circulation: a case report. Korean J Anesthesiol 2014; 66:252-5. [PMID: 24729851 PMCID: PMC3983425 DOI: 10.4097/kjae.2014.66.3.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/15/2013] [Accepted: 02/15/2013] [Indexed: 11/10/2022] Open
Abstract
An 18-year-old male with a Fontan circulation underwent excision of a pheochromocytoma after conversion from laparoscopic surgery. The pneumoperitoneum established for laparoscopic surgery may have adverse effects on the Fontan circulation, because it increases the intra-abdominal pressure (IAP), intra-thoracic pressure, pulmonary vascular resistance, and systemic vascular resistance (SVR), and decreases cardiac preload and cardiac output. Meticulous monitoring is also required during carbon dioxide exsufflation, because a rapid decrease in IAP can provoke hemodynamic deterioration by decreasing venous return and SVR. Furthermore, catecholamines released by the pheochromocytoma can worsen the hemodynamic status of Fontan circulation during surgery. Therefore, sophisticated intraoperative anesthetic care is required during laparoscopic pheochromocytoma excision in patients with a Fontan circulation.
Collapse
Affiliation(s)
- Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Karam Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong-Hee Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chong-Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
10
|
Tang YK, Flora Tsang HF, Ranjan Das S, Vance ML, Kussman BD. CASE 6—2013 Perioperative Management of an Adult Patient With Tetralogy of Fallot and Pheochromocytoma. J Cardiothorac Vasc Anesth 2013; 27:1399-406. [DOI: 10.1053/j.jvca.2013.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Indexed: 01/09/2023]
|
11
|
Latendresse TR, Goldin AB, Jonmarker C. Anesthesia for pheochromocytoma resection in a child with Fontan circulation. Can J Anaesth 2011; 58:642. [DOI: 10.1007/s12630-011-9507-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/08/2011] [Indexed: 11/29/2022] Open
|
12
|
Yuki K, Shamberger RC, McGowan FX, Seefelder C. The Perioperative Management of a Patient With Fontan Physiology for Pheochromocytoma Resection. J Cardiothorac Vasc Anesth 2008; 22:748-50. [PMID: 18922437 DOI: 10.1053/j.jvca.2007.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Indexed: 11/11/2022]
|
13
|
|
14
|
Yoshihara A, Tanabe A, Saito H, Hizuka N, Ishizawa A, Horikawa R, Takano K. A case of malignant pheochromocytoma with Holt-Oram syndrome. Endocr J 2008; 55:153-9. [PMID: 18250543 DOI: 10.1507/endocrj.k07e-011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 23-year-old female patient with malignant pheochromocytoma was admitted to the Tokyo Women's Medical University. The patient had been clinically diagnosed with Holt-Oram syndrome at birth. Since she had complex congenital heart disease, chronic heart failure, and severe hypoxia, the risk surrounding surgery to remove the primary tumor was predicted to be very high, and subsequently, chemotherapy was performed. The patient was not able to continue chemotherapy due to adverse effects. However, for one year, both her hypertension and catecholamine-dependent symptoms were well controlled by an alpha-adrenergic and beta-adrenergic receptor blockade, although the patient did experience high plasma norepinephrine levels. To our knowledge, this is the first report of a patient with the combination of malignant pheochromocytoma and Holt-Oram syndrome. A correlation between chronic hypoxia and pheochromocytoma has been reported. This instructive case reminds us to consider the possibility of pheochromocytoma with congenital heart disease when these types of unexpected or unusual symptoms are encountered.
Collapse
Affiliation(s)
- Ai Yoshihara
- Department of Medicine, Institute of Clinical Endocrinology, Tokyo Women's Medical University, Japan
| | | | | | | | | | | | | |
Collapse
|
15
|
Chung SJ, Lee YA, Shin CH, Yang SW, Bae EJ, Noh JI. Pheochromocytoma associated with cyanotic congenital heart disease. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.1.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Seung Joon Chung
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Eun Jung Bae
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| | - Jung Il Noh
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
| |
Collapse
|
16
|
Cherqaoui I, Raux O, Dehour L, Rochette A, Dadure C, Capdevila X. Transpulmonary thermodilution hemodynamic monitoring for pheochromocytoma surgery in a child with complex congenital heart disease. Paediatr Anaesth 2006; 16:1277-80. [PMID: 17121560 DOI: 10.1111/j.1460-9592.2006.01997.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hemodynamic alterations related to pheochromocytoma surgery may lead to decompensation with an associated cardiac malformation. Moreover, they are incompletely described in children because of potential hazards of invasive monitoring. We report transpulmonary thermodilution hemodynamic monitoring during pheochromocytoma surgery in a child with a complex congenital heart malformation. Comprehensive analysis of hemodynamic events was obtained that guided therapeutic decisions. Cardiac function was preserved and no complication occurred.
Collapse
Affiliation(s)
- Imane Cherqaoui
- Department of Anesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, and Montpellier School of Medicine, Montpellier, France
| | | | | | | | | | | |
Collapse
|
17
|
Hack H. Use of the Esophageal Doppler Machine to help guide the intraoperative management of two children with pheochromocytoma. Paediatr Anaesth 2006; 16:867-76. [PMID: 16884470 DOI: 10.1111/j.1460-9592.2005.01838.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The anesthetic management of pheochromocytoma has been based upon the intraoperative control of blood pressure and fluid balance following adequate preoperative preparation. This can be difficult, especially in the presence of significant comorbidity such as cardiac or renal dysfunction. Two cases of children with pheochromocytoma are reported where the introperative management of fluid balance and blood pressure control were guided by measurement of changes in descending aortic blood flow using an esophageal Doppler probe. The advantages of such a technique compared with more invasive monitors are discussed.
Collapse
Affiliation(s)
- Henrik Hack
- Department Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester M27 4HA, UK.
| |
Collapse
|