Lyu Ting, Niu Jianhua, Liu Zhihai, Li Tong
Department of Intensive Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Front Cardiovasc Med. 2022 Mar 21;9:788644. doi: 10.3389/fcvm.2022.788644. eCollection 2022.
Pheochromocytoma-induced cardiomyopathy is a rare but potentially life-threatening complication of pheochromocytoma. It mimics the patterns of stress-induced cardiomyopathy. In severe cases, patients can develop refractory cardiogenic shock, which might require mechanical circulatory support.
We presented a case of 54-year-old female who developed refractory cardiogenic shock, following an elective orthopaedic surgery complicated by cardiac arrest, requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. After urgent coronary catheterisation revealed normal coronary arteries, further evaluation of the aetiology of cardiogenic shock revealed pheochromocytoma. With a diagnosis of pheochromocytoma-induced cardiomyopathy, the patient had accelerated preoperative alpha adrenergic blockade preparation for a total of 6 days and subsequently had the tumour removed under VA-ECMO support. Postoperatively, the patient recovered well and was off ECMO support and extubated a few days later.The optimal management of pheochromocytoma-induced cardiomyopathy, especially for severe cases, is still unclear. Indeed, some cases will require mechanical circulatory support to allow left ventricular function recovery. But our case also showed that it was possible to introduce alpha blockade safely whilst the patient is on VA-ECMO and has the pheochromocytoma removed with VA-ECMO support after accelerated preoperative preparation.
嗜铬细胞瘤诱发的心肌病是嗜铬细胞瘤一种罕见但可能危及生命的并发症。它模仿应激性心肌病的模式。在严重情况下，患者可发生难治性心源性休克，这可能需要机械循环支持。
我们报告了一例54岁女性患者，在择期骨科手术后并发心脏骤停，继而出现难治性心源性休克，需要静脉-动脉体外膜肺氧合（VA-ECMO）支持。紧急冠状动脉导管检查显示冠状动脉正常后，对心源性休克病因的进一步评估发现了嗜铬细胞瘤。诊断为嗜铬细胞瘤诱发的心肌病后，患者术前加速进行α肾上腺素能阻滞剂准备共6天，随后在VA-ECMO支持下切除肿瘤。术后，患者恢复良好，几天后脱离ECMO支持并拔管。嗜铬细胞瘤诱发的心肌病的最佳治疗方法，尤其是对于严重病例，仍不明确。确实，一些病例需要机械循环支持以使左心室功能恢复。但我们的病例也表明，在患者接受VA-ECMO治疗期间安全地进行α阻滞剂治疗，并在术前加速准备后在VA-ECMO支持下切除嗜铬细胞瘤是可行的。
