Multimodal anaesthesia for mitral valve replacement in a patient with a pheochromocytoma
DOI:
https://doi.org/10.25751/rspa.33322Keywords:
Cardiothoracic surgery, Pheochromocytoma, Cardiac anesthesiaAbstract
Pheochromocytomas are rare neuroendocrine tumours that produce and store catecholamines. Intraoperatively, the release of excessive amounts of catecholamines can produce life-threatening cardiovascular complications.
This is a case report of a woman in her 60s recently diagnosed with a pheochromocytoma in need of a mitral valve replacement due to anterior leaflet prolapse and ruptured chord.
Due to the possibility of worsening mitral regurgitation and cardiovascular collapse after a hypertensive crisis during adrenalectomy we prioritised the cardiac surgery.
Intraoperatively, we performed a multimodal total intravenous anaesthesia with propofol and low-dose infusions of remifentanil and dexmedetomidine. Hemodynamic stability was maintained throughout the procedure and two months later the patient underwent a laparoscopic adrenalectomy uneventfully.
Although pheochromocytoma removal is usually a priority surgery, when facing serious cardiovascular pathology, such as severe mitral regurgitation, it may be a better option to prioritise the cardiac surgery over the pheochromocytoma removal.
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Copyright (c) 2023 Filipa Portela, André Rato
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