Pheochromocytoma induced fulminant cardiogenic shock following laparoscopic salpingectomy, successfully managed with extracorporeal membrane oxygenation
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Tiberiu Ezri, MD1* Abraham Golan, MD, FRCOG2, Lior Sasson, MD3, Yoseph Rozenman MD4
1Associate Professor & Head, Department of Anesthesia,
2Professor & Head, Department of Obstetrics & Gynecology,
3Lecturer and Head, Department of Cardiothoracic Surgery,
4Associate Professor & Head, Department of Cardiology, the Edith Wolfson Medical Center, Holon, Israel, Affiliated to Sackler Medical School, Tel Aviv University, Israel and *Outcomes Research Group, Cleveland, OH
Abstract
Pheochromocytoma is a rare disorder caused by functioning tumor composed of chromaffin cells that secrete catecholamines. Patients with undiagnosed pheochromocytoma may have a high mortality. We present a young female patient with a preoperative diagnosis of asymptomatic neurofibromatosis who underwent laparoscopic salpyngectomy for ectopic pregnancy. She subsequently developed a severe acute catecholamine-induced toxic cardiomyopathy presenting with cardiogenic and noncardiogenic pulmonary edema and shock. Intra-aortic balloon pump (IABP) support, combined with inotropic therapy, was unsuccessful in restoring hemodynamic stability. As a desperate measure, the patient was connected to an extracorporeal membrane oxygenation (ECMO) device. Within a few days, her condition gradually improved and she was weaned from ECMO and mechanical ventilation. A left adrenal pheochromocytoma was subsequently diagnosed and successfully removed laparoscopically, after two weeks of patient preparation.
The patient was discharged home with no serious complications.
We discuss the clinical presentation and treatment of catecholamine-induced cardiomyopathy.
Keywords: pheochromocytoma, cardiopulmonary failure, salpingectomy, anesthesia, extracorporeal membrane oxygenator
J Rom Anest Terap Int 2009; 16: 154-158
CAZURI CLINICE
Şoc cardiogen fulminant indus de un feocromocitom după salpingectomie laparoscopică, tratat cu succes prin oxigenare extracorporală de membrană |
