Unusual cardiogenic shock due to pheochromocytoma: recovery after bridge-to-bridge (extracorporeal life support and DeBakey ventricular assist device) and right surrenalectomy.

摘要

Acute adrenergic cardiomyopathy resulting in intractable pulmonary edema and life-threatening cardiogenic shock is an unusual revelation of a pheochromocytoma.1"4 Dealing with such a patient, we have performed a bridge-to-bridge (extracorporeal life support [ECLS] secondarily switched for a DeBakey axial pump ventricular assist device) associated to a right surrenalectomy, allowing cardiac function recovery.A 49-year-old man with no previously known pathology or risk factors complained of brutal abdominal pain, vomiting, headache, and malaise. On arrival to his referring hospital, he presented with a massive pulmonary edema, followed by cardiogenic shock and cardiac arrest requiring cardiopulmonary resuscitation. Initial laboratory findings showed troponin I and pro-brain natriuretic peptid levels at 0.23 mug/L and 5667 pg/mL, respectively (normal, <0.06 mug/L and <84 pg/mL, respectively). Arterial blood gases revealed a partial oxygen pressure of 218 mm Hg at a fraction of inspired oxygen of 1. Electrocardiography did not identify signs of ischemia or infarction, and chest radiography showed bilateral infiltration consistent with pulmonary edema. An echocardiogram revealed a severe global hy-pokinesia (left ventricular ejection fraction, 12%) without ventricular dilatation, no valvulopathy, no pulmonary artery hypertension, and a nonincreased septal thickness. Hemodynamic and respiratory status worsened despite mechanical ventilation, volume expansion, and an intake of dobutamine (8 fxg) and norepinephrine (2 jag). The results of coronorography were normal, and during the procedure, an intra-aortic balloon pump was introduced. A thoracoabdominal computed tomographic (CT) scan revealed a 3 X 3-cm mass in the right adrenal gland. The diagnosis was orientated toward pheochromocytoma, and initial dosages of catecholamines were provided.