Anaesthetic management of cardiac phaeochromocytoma: A case series

Highlights

• Primary cardiac phaeochromocytoma is a rare form of catecholamine-secreting heart tumour rarely encountered by anaesthetists.

• We present a single centre case series of four cardiac phaeochromocytoma surgical excisions.

• Perioperative management may require aggressive alpha and cautious beta-adrenergic blockage.

• Intraoperative management requires careful use of vasoactive medications and fluids.

• We advocate for the use of cardiac pulmonary bypass when excising cardiac phaeochromocytoma.

Abstract

Introduction

Primary cardiac phaeochromocytoma is uncommon, with few anaesthetists encountering this rare pathology in clinical practice. Further, there is little information available on the detailed intraoperative and postoperative haemodynamics and principles of the anaesthetic management of this condition.

Presentation of case

We present a retrospective, single-centre case series of four patients with cardiac phaeochromocytoma who presented for surgical excision. We describe the perioperative evaluation and management of these patients, consideration of the requirements for cardiopulmonary bypass, and the analgesic and pharmacologic interventions needed to maintain stable perioperative and intraoperative haemodynamics.

Discussion

Octreotide scintigraphy, in addition to echocardiography, cardiac MRI and coronary angiography proved vital in the preoperative evaluation of these patients. Preoperative anaesthetic management of cardiac phaeochromocytoma involved alpha-adrenergic blockade, judicious beta-adrenergic blockade and hydration. Intraoperatively, the administration of vasodilatory agents prior to, and vasoconstricting agents with volume therapy after tumour excision, were the key elements of anaesthetic management. Furthermore, we believe that cardiopulmonary bypass plays a pertinent role in cardiac phaeochromocytoma excision and that the risks and benefits of pulmonary artery catheters should be considered before use in these patients.

Conclusion

Management of cardiac phaeochromocytoma is complex and demands careful perioperative planning and management. Perioperative morbidity is common and anaethetists play an important role in achieving a successful outcome for patients who present for excision of cardiac phaeochromocytoma.