Management of concurrent aortic stenosis and pheochromocytoma

Abstract

A man in his mid 60s with known aortic stenosis developed progressive symptoms. Echocardiography confirmed severe calcific aortic stenosis. Further evaluation revealed an elevated white blood cell count leading to a diagnosis of chronic lymphocytic leukaemia. CT of the abdomen revealed a left adrenal mass, confirmed by MRI. 24-hour urine catecholamines were elevated, confirming the diagnosis of a pheochromocytoma.This case was complicated by the concurrent aortic stenosis and pheochromocytoma, requiring considerable multidisciplinary teamwork to develop a safe management strategy. A decision to perform a transcatheter aortic valve replacement (TAVR) with alpha and beta blockade with monitored anaesthesia care followed by laparoscopic adrenalectomy and postoperative haemodynamic control was made. A successful TAVR procedure was performed, complicated only by postoperative transient atrial tachycardia followed 6 weeks later by a laparoscopic robotic-assisted left adrenalectomy. The patient recovered fully and was discharged 2 days later.