Emergency aortic valve replacement complicated by unmanaged pheochromocytoma

Abstract

A 53‐year‐old male undergoing emergency aortic valve replacement for infective endocarditis developed a hypertensive crisis early during the operation. Suspecting a pheochromocytoma, intravenous phentolamine was immediately administered, after which the procedure was completed as scheduled. Although quite rare, a pheochromocytoma can be encountered during emergency open heart surgery; thus, early recognition of abnormal blood pressure change and appropriate management are important. Here, we present details of blood pressure control mainly by use of phentolamine, in this case, to demonstrate effective management of a hypertensive crisis during emergency cardiac surgery because of a pheochromocytoma.

Pheochromocytomas and Abdominal Paragangliomas: A Practical Guidance

“…Although phenoxybenzamine prevented intraoperative systolic blood pressure above the target range and hemodynamic instability better than doxazosin, there was no difference in side effects, complications or length of hospital stay between the two groups. In a hypertensive crisis, an intravenous alpha-blocker such as phentolamine is preferred over oral alpha-blockers due to its rapid action [ 17 , 103 ].…”