Mechanical bridge to recovery in pheochromocytoma myocarditis

Westaby, Stephen; Shahir, Ashwin; Sadler, Gregory P.; Flynn, Fidelma; Ormerod, Oliver

doi:10.1038/nrcardio.2009.58

Cited by 20 publications

(13 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because exposure to elevated epinephrine levels may engender cardiac dysfunction and sympathetic receptor downregulation, catecholamines usually used to treat cardiogenic shock could be less effective or even exacerbate pheochromocytoma-induced cardiogenic shock. Some authors proposed alternative agents that do not act via adrenergic receptors, such as calcium-sensitizing agents or phosphodiesterase III inhibitors, but no available evidence supports those decisions [11, 12]. …”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock

Hékimian

Kharcha

Bréchot

et al. 2016

Ann. Intensive Care

View full text Add to dashboard Cite

BackgroundPheochromocytoma, a rare catecholamine-producing tumor, might provoke stress-induced Takotsubo-like cardiomyopathy and severe cardiogenic shock. Because venoarterial-extracorporeal membrane oxygenation (VA-ECMO) rescue of pheochromocytoma-induced refractory cardiogenic shock has rarely been reported, we reviewed our ICU patients’ presentations and outcomes.MethodsAll pheochromocytoma-induced refractory cardiogenic shock cases managed with VA-ECMO (January 2007–March 2015) were prospectively included and reviewed. We also performed a systematic review on this topic.ResultsNine patients (7 women, 2 men; 31–51 [median, 43 (IQR 36–49) years old]) were included; none had a previously known pheochromocytoma. Six of them had medical histories suggestive of the diagnosis: palpitations and headaches for several months for four, multiple endocrine neoplasia syndrome type 1 for one and recurrent Takotsubo disease for one; at hospital admission, all were hypertensive despite cardiogenic shock. Three others had an identified surgical triggering factor. All nine patients rapidly developed refractory cardiogenic shock with very severe left ventricular (LV) impairment (LV ejection-fraction range 5–20%; LV outflow-tract velocity–time integral range 3–8 cm). Seven patients’ abdominal computed tomography scans showed pheochromocytoma-suggestive adrenal gland tumors (no scan during ICU stay for 2). Despite VA-ECMO implantation, three patients died of refractory multiple organ failure. For the six others, myocardial function improved and ECMO was removed 3–7 days post-implantation; α- and β-blockers were progressively introduced. Five survivors underwent pheochromocytoma excision 3 weeks–4 months post-ICU discharge, with satisfactory outcomes. One patient, whose pheochromocytoma was diagnosed 1 year after the index event, underwent uneventful surgical adrenalectomy. Systematic review retrieved 40 cases of pheochromocytoma-induced cardiogenic shock requiring mechanical support (mostly ECMO), with a mortality rate of 7%. Pheochromocytoma was removed surgically after mechanical support weaning in 31 patients and during mechanical support in 5. Four were not operated.ConclusionsPheochromocytoma is a rare but reversible cause of cardiogenic shock amenable to VA-ECMO rescue. Adrenal gland imaging should be obtained for all patients with unexplained cardiogenic shock. Lastly, it might be safer to perform adrenalectomy several weeks after the initial catastrophic presentation, once recovery of LV systolic function is complete.

show abstract

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock

Hékimian

Kharcha

Bréchot

et al. 2016

Ann. Intensive Care

View full text Add to dashboard Cite

show abstract

“…Therefore, conventional supportive treatment for type B crises is volume resuscitation. Case reports describe the use of various inotropes and vasopressors (including adrenaline, noradrenaline, dopamine, dobutamine, vasopressin and levosimendan) in an attempt to manage sustained hypotension and circulatory compromise . It is unclear which if any of these provide significant benefit in the circumstances of catecholamine excess, but desensitization to noradrenaline/adrenaline may be noted.…”

Section: Managementmentioning

confidence: 99%

Phaeochromocytoma crisis

Whitelaw

Prague

Mustafa

et al. 2013

Clinical Endocrinology

100

166

View full text Add to dashboard Cite

SummaryPhaeochromocytoma crisis is an endocrine emergency associated with significant mortality. There is little published guidance on the management of phaeochromocytoma crisis. This clinical practice update summarizes the relevant published literature, including a detailed review of cases published in the past 5 years, and a proposed classification system. We review the recommended management of phaeochromocytoma crisis including the use of alpha-blockade, which is strongly associated with survival of a crisis. Mechanical circulatory supportive therapy (including intra-aortic balloon pump or extra-corporeal membrane oxygenation) is strongly recommended for patients with sustained hypotension. Surgical intervention should be deferred until medical stabilization is achieved.

show abstract

“…It is reported that catecholamine may induce cardiac injury through multiple mechanisms including catecholamine-induced endothelium increased oxygen demand through positive inotropic and chronotropic effects, activating renin-angiotensin system, and prohypertrophic effects mediated by alpha-1A adrenergic receptor. 14,15 However, the clinical studies reported mixed results about correlations between endocrine and cardiological findings. 1,16,17 In our study, the systolic pressure and LV mass index increased with in-…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Subclinical left ventricular systolic dysfunction detected by two‐dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction

et al. 2017

View full text Add to dashboard Cite

show abstract

Mechanical bridge to recovery in pheochromocytoma myocarditis

Abstract: Intra-aortic balloon pump, levosimendan and dobutamine infusion, alpha-blockade with phentolamine, surgical removal of the pheochromocytoma, Levitronix (Levitronix LLC, Waltham, MA) left ventricular assist device implantation.

Cited by 20 publications

References 18 publications

Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock

Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock

Phaeochromocytoma crisis

Subclinical left ventricular systolic dysfunction detected by two‐dimensional speckle tracking echocardiography in patients with pheochromocytoma and paraganglioma and preserved ejection fraction

Contact Info

Product

Resources

About