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.
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.
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Baillargeon, JP., Pek, B., Teijeira, J. et al. Combined surgery for coronary artery disease and pheochromocytoma. Can J Anaesth 47, 647–652 (2000). https://doi.org/10.1007/BF03018998
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DOI: https://doi.org/10.1007/BF03018998