Current generation LVADs provide continuous blood flow which has been shown to increase sympathetic tone. Pheochromocytoma is a rare neuroendocrine tumor which classically presents with episodic hypertension, palpitations and headaches. Careful perioperative management with alpha blockade is required to prevent cardiovascular complications, specifically hypertensive crisis. Here we present a description of perioperative management of pheochromocytoma in a patient with a continuous flow LVAD. Traditional assessment of sympathetic tone is challenging in LVAD patients due to the presence of continuous circulatory flow. Invasive management via an arterial line was useful in perioperative management, allowing for accurate circulatory monitoring and hemodynamic control. Finally, close coordination of multiple specialties including advanced heart failure, anesthesia, and endocrinology was vital to the positive outcome in this case.
Albulushi, Arif MD; Zolty, Ronald MD PHD; Lowes, Brian MD, PhD; Duhacheck-Stapleman, Amy L. MD; Sandler, Tal MD; Sullivan, James N. MD; and Stoller, Douglas MD PHD
"Perioperative Management of Pheochromocytoma Resection in a Patient with a Continuous Flow Left Ventricular Assist Device,"
Journal of the Saudi Heart Association: Vol. 32
, Article 22.
Available at: https://doi.org/10.37616/2212-5043.1026
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