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Combined surgery for coronary artery disease and pheochromocytoma
J P Baillargeon1, B Pek, J Teijeira
1Department of Medicine, Université de Sherbrooke, Centre Universitaire de Santé de l'Estrie, Québec, Canada.
Insights
This case study highlights a successful combined surgery for severe coronary artery disease and pheochromocytoma. The combined coronary artery bypass grafting (CABG) and adrenalectomy procedure offered a cure for both conditions.
Area of Science:
- Cardiology
- Endocrinology
- Surgical Oncology
Background:
- Pheochromocytoma, a rare adrenal tumor, can cause severe hypertension.
- Coronary artery disease poses significant risks, especially in patients with uncontrolled hypertension.
Observation:
- A 55-year-old woman with pheochromocytoma developed an acute myocardial infarction during preoperative preparation for adrenalectomy.
- The patient required urgent coronary artery bypass grafting (CABG) for triple-vessel disease.
Findings:
- A combined surgical approach, performing CABG followed by adrenalectomy, was successfully executed.
- The patient experienced a normal postoperative recovery with a cure for both pheochromocytoma and coronary artery disease.
Implications:
- Combined CABG and adrenalectomy is a viable and effective treatment strategy for patients with concurrent severe coronary artery disease and pheochromocytoma.
- This approach may offer a curative solution for these complex co-existing conditions.
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.