Hypertension and Intrapericardial Paraganglioma: An Exceptional Presentation of Multiple Endocrine Neoplasia Type IIA Syndrome

Imperatori, Andrea; Monte, Lavinia De; Rotolo, Nicola; Dionigi, Gianlorenzo; Uccella, Silvia; Mariscalco, Giovanni; Dominioni, Lorenzo

doi:10.1161/hypertensionaha.111.180992

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…Usually, the operation was performed through a median sternotomy under hypothermic cardiopulmonary bypass. An alternative method to approach the tumor was the right or left thoracotomy, which was recorded in 15 cases . In addition, the tumor resection was performed without cardiopulmonary bypass in four cases .…”

Section: Resultsmentioning

confidence: 99%

“…An alternative method to approach the tumor was the right or left thoracotomy, which was recorded in 15 cases . In addition, the tumor resection was performed without cardiopulmonary bypass in four cases . In most cases, the tumor was firmly adherent to the adjacent tissues; therefore, a portion of the affected structures had to be excised (the reported structures including left and right atrial wall, interatrial septum, pulmonary artery/vein, right ventricular wall, aortic sinus, aortic valve leaflets, and superior vena cava), and the defects were repaired by patches of pericardium (autologous or bovine), Dacron or polytetrafluoroethylene.…”

Section: Resultsmentioning

confidence: 99%

“…Occasionally, CPGL may be manifested as one of the multiple endocrine neoplasia syndromes and be accompanied by similar lesions in other locations. 3,4 In such cases, it was difficult to clarify which one was the primary tumor. Familial PGLs history was recorded in four patients.…”

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Cardiac Paragangliomas

2014

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Cardiac Paragangliomas

2014

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“…Phentolamine was administered in boluses of 1-2 mg (50 mg total) (Figure 1). After successful resection of the intrapericardial mass, which was histologically shown to be a chromogranin A-positive paraganglioma (Figure 3), the patient was discharged normotensive [23]. …”

Section: Perioperative Management Of Hypertensionmentioning

confidence: 99%

Management of Hypertension in Intrapericardial Paraganglioma

Rotolo

Imperatori

Bacuzzi

et al. 2014

International Journal of Hypertension

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Functioning paraganglioma is extra-adrenal catecholamine-secreting tumours that may cause secondary hypertension. Primary intrapericardial paragangliomas are very rare and are located adjacent to the great vessels or heart, typically near the left atrium. These tumours are an exceptionally uncommon finding during the investigation of refractory hypertension. However, in recent years, intrapericardial paragangliomas have been diagnosed incidentally with increased frequency, due to the extensive use of radiologic chest imaging. The mainstay of treatment of functioning intrapericardial paraganglioma is surgical removal, which usually achieves blood pressure normalization. Due to the locations of these tumours, the surgical approach is through a median sternotomy or posterolateral thoracotomy, and manipulation-induced catecholamine release may cause paroxysmal hypertension. Typically in these patients, blood pressure fluctuates dramatically intra- and post-operatively, increasing the risk of cardiovascular complications. We review here the current modalities of perioperative fluid and hypotensive drug administration in the setting of surgery for functioning intrapericardial paraganglioma and discuss the recently proposed paradigm shift that omits preoperative preparation.

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“…However, since the tumor was surrounded by pseudocapsule, this may have controlled intraoperative bleeding from the tumor at the time of complete resection. On the other hand, at radical surgery, some researchers employed cardiopulmonary bypass [1, 5] in order to avoid the intraoperative catastrophic hemorrhage as we experienced, but others reported a case successfully treated without cardiopulmonary bypass [4, 6]. We considered the need initially to secure a good operative field, namely, by posterolateral thoracotomy, and successfully undertook repair of the atrial laceration under the excellent operative field without cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Successful Removal of Giant Intrapericardial Paraganglioma via Posterolateral Thoracotomy

Yamamoto¹,

Kodama²,

Yamato³

et al. 2014

Case Reports in Surgery

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Intrapericardial paraganglioma remains a surgical challenge because of its hypervascular nature and firm adhesion to adjacent mediastinal structures. Here, we describe a 63-year-old female with a giant nonfunctioning intrapericardial paraganglioma tightly adhered to the left atrium. Marginal but complete resection of the tumor was achieved via right posterolateral thoracotomy. At the time of dissection between the tumor and the left atrial wall, we encountered massive hemorrhage leading to cardiac arrest. We were able to repair the wall laceration with minimal time under an optimal operative field, which avoids air embolism. She was discharged without complications and is currently in good health with no recurrence or metastasis for 15 months. Based on our experience, cardiopulmonary bypass should be considered, if surgeons are able to secure suitable sites for arterial and venous cannulations while right posterolateral thoracotomy is employed.

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Hypertension and Intrapericardial Paraganglioma: An Exceptional Presentation of Multiple Endocrine Neoplasia Type IIA Syndrome

Cited by 5 publications

References 6 publications

Cardiac Paragangliomas

Cardiac Paragangliomas

Management of Hypertension in Intrapericardial Paraganglioma

Successful Removal of Giant Intrapericardial Paraganglioma via Posterolateral Thoracotomy

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