Catastrophic catecholamine-induced cardiomyopathy rescued by extracorporeal membrane oxygenation in recurrent malignant pheochromocytoma

Min, Daniel

doi:10.12701/yujm.2019.00213

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…Similar data can be seen in literature. 17,18,20 Preoperative antihypertensive medication with monotherapy with alpha blockers (unable to tolerate due to hypertensive crises every few days) and intraoperative infusion of nitroprusside sodium (Nitropress) did not prevent the complication. The large size of the pheochromocytoma was the main reason for the undesired outcome.…”

Section: Discussionmentioning

confidence: 99%

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Catecholamine-induced cardiomyopathy - a clinical case

Vladimirova-Kitova¹,

Kitov²,

Uchikov³

et al. 2022

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A 27-year-old patient presented with a 3-month history of episodic headaches and persistently rising blood pressure (up to 240/120). The clinical, laboratory, and instrumental findings (episodes of severe hypertension, increased levels of metanephrine in urine, and MRI showing a mass of 5.1×5.5 cm in diameter) led us to the diagnosis of pheochromocytoma of the right adrenal grand. Preoperative medication included alpha blockers, calcium channel blockers, and plasma. The right adrenal gland was completely removed using the retroperitoneal access. During the extraction of the tumour, a ventricular tachycardia was recorded after which acute heart failure issued. In the first few hours, echocardiographic imaging showed a reduced EF of 9% – catecholamine-induced cardiomyopathy. The patient underwent a complex and adequate reanimation in the intensive care unit which lasted 20 days. A slow but steady increase in the ejection fraction along with a decrease in congestion was observed. Magnetic resonance imaging was used to confirm the normalisation of myocardial morphology. A German histological laboratory was used to confirm the benign form of the tumour. For the next three months, the patient was on a standard therapy with beta blockers, angiotensin-converting-enzyme inhibitor and mineralocorticoid antagonists. Тhe catecholamine surge during the removal of a large pheochromocytoma could lead to severe cardio-vascular complication, even with a complete and adequate preoperative protective medication. The reversibility of the process implies the necessity of an adequate and timely postoperative treatment for a complete involution of the pathomorphological changes.

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Section: Discussionmentioning

confidence: 99%

“…1). 16,17 Preoperative medication strictly followed the guideline requirements. The patient, prior to the operation, was on low-to-moderate doses of alpha blockers for two weeks.…”

Section: Case Reportmentioning

confidence: 99%

Catecholamine-induced cardiomyopathy - a clinical case

Vladimirova-Kitova¹,

Kitov²,

Uchikov³

et al. 2022

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“…In addition, several cases of secondary circulatory crises in patients with pheochromocytoma have been reported along with a summary of cases that used VA-ECMO transitional support therapy ( 13 , 17 , 18 ). Severe respiratory and circulatory failure due to chemotherapy drug-related cardiopulmonary injuries can also require ECMO support.…”

Section: Discussionmentioning

confidence: 99%

Successful Use of Extracorporeal Life Support and Continuous Renal Replacement Therapy in the Treatment of Cardiogenic Shock Induced by Tumor Lysis Syndrome in a Pediatric Patient With Lymphoma: A Case Report

et al. 2022

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The use of extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary failure in children with malignant tumors is controversial. There are few reports on the use of ECMO in the treatment of children with tumor lysis syndrome. This article reports a case of a 9-year-old girl who presented with hyperkalemia and cardiogenic shock. The discovery of an abdominal mass with critical ultrasound provided key evidence for the initial diagnosis of tumor lysis syndrome. Cardiopulmonary resuscitation was performed for 1 h. Veno-arterial ECMO was installed at the bedside to provide cardiopulmonary support for the patient and was combined with continuous renal replacement therapy (CRRT) to improve her internal environment. The patient was ultimately diagnosed with mature B-cell lymphoma with tumor lysis syndrome. A severe electrolyte disorder led to cardiogenic shock. After the electrolyte imbalance was corrected, the patient's heart function gradually improved, ECMO was successfully weaned, and chemotherapy was continued with the support of CRRT. One month after ECMO weaning, the organ function of the patient had recovered and there were no serious complications. In this case report, we paid attention to the rapid diagnosis of the etiology behind a patient's shock with critical ultrasound as well as the initiation and management of extracorporeal cardiopulmonary resuscitation (ECPR), which provided us with valuable experience using VA-ECMO on critically ill children with tumors. It is also important evidence for the use of ECMO in the treatment of children with cardiopulmonary arrest secondary to malignancy.

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