The risk of development of perioperative myocardial lesions and acute left ventricular insufficiency in the patients presenting with pheochromocytoma

Abstract

Differential diagnostics of coronary heart disease (CHD) and catecholamine-induced cardiomyopathy was undertaken in 19 of the 106 patients presenting with pheochromocytoma. Group 1 included 13 patients having the history of acute myocardial infarction. Diagnostics of CHD was performed following the adequate preoperative alpha-blockade (supplemented by Β-blockade whenever indicated). Group 2 was comprised of 6 patients suffering pulmonary oedema (normotensive, 10-70 min after removal of the tumour) and showing the elevated levels of biomarkers of myocardial necrosis and/or ischemic-type changes of ECG in the early postoperative period. The clinically significant myocardial ischemia requiring correction was documented only in one of the 19 patients. The two groups were not significantly different in terms of the mean tumour size and duration of surgery, the quality of preoperative compensation, and intraoperative fluctuations of arterial pressure. The mean age of the patients in group 1 (47 years) was much higher than that in group 2 (29 years). All patients in group 2 exhibited the predominantly adrenalin-type secretion whereas 10 patients of group 1 had the noradrenalin-type secretion and two others mixed-type secretion with the predominance of noradrenalin release. It was shown that the patients with the predominantly adrenaline-type secretion by the tumour were at higher risk of pulmonary oedema. The possibility of application of alpha-methylparatyrosine having beneficial effect on contractile activity of myocardium as the main agent for preoperative preparation is discussed.