Aortic valve replacement with a pulmonary autograft in infants with critical aortic stenosis

Abstract Background Pheochromocytoma is a rare medical condition caused by catecholamine-secreting tumor cells. Operative resection can be associated with significant hemodynamic fluctuations due to the nature of the tumor, as well as associated post-resection vasoplegia. To allow for cardiovascular recovery before surgery, patients require pre-operative alpha-adrenergic blockade, which would be limited in the setting of co-existent severe aortic stenosis. In this report, we describe a patient with severe aortic stenosis and symptomatic pheochromocytoma. Case presentation A 51-year-old man with severe aortic stenosis (valve area 0.8 cm2) was found to have a highly active 4 × 4 cm left adrenal pheochromocytoma. Alpha-adrenergic blockade for his pheochromocytoma was limited by syncope in the setting of his aortic stenosis. Open aortic valve replacement (AVR) was performed, followed by adrenalectomy the next day. The perioperative course for each surgical procedure was hemodynamically volatile, exacerbated by severe alcohol withdrawal. During the adrenalectomy, cardiogenic and vasoplegic shock developed immediately after securing the vascular supply to his tumor. This shock was refractory to vasopressin and methylene blue, but responded well to angiotensin II and epinephrine. After both surgeries were completed, his course was further complicated by severe ICU psychosis, ileus, fungal bacteremia, pneumonia/hypoxic respiratory failure and atrial fibrillation. He ultimately recovered and was discharged from the hospital after 38 days. Conclusion To our knowledge, this is the first report of surgical AVR and pheochromocytoma resection in a patient with critical aortic stenosis. The appropriate order and timing of surgeries when both these conditions co-exist remains controversial.

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Open Aortic Valve Replacement Followed by Open Adrenalectomy In A Patient With Symptomatic Pheochromocytoma and Critical Aortic Stenosis: A Case Report

10.21203/rs.3.rs-127852/v1 ◽

2020 ◽

Author(s):

Igor Feinstein ◽

Tiffany Lee ◽

Sameer Khan ◽

Lindsay Raleigh ◽

Fred Mihm

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Medical Condition ◽

Severe Aortic Stenosis ◽

Vascular Supply ◽

Adrenergic Blockade ◽

Critical Aortic Stenosis ◽

Highly Active

Abstract Background: Pheochromocytoma is a rare medical condition caused by catecholamine-secreting tumor cells. Operative resection can be associated with significant hemodynamic fluctuations due to the nature of the tumor, as well as associated post-resection vasoplegia. To allow for cardiovascular recovery before surgery, patients require pre-operative alpha-adrenergic blockade, which would be limited in the setting of co-existent severe aortic stenosis. In this report, we describe a patient with severe aortic stenosis and symptomatic pheochromocytoma. Case presentation: A 51-year-old man with severe aortic stenosis (valve area 0.8 cm2) was found to have a highly active 4x4 cm left adrenal pheochromocytoma. Alpha-adrenergic blockade for his pheochromocytoma was limited by syncope in the setting of his aortic stenosis. Open aortic valve replacement (AVR) was performed, followed by adrenalectomy the next day. The perioperative course for each surgical procedure was hemodynamically volatile, exacerbated by severe alcohol withdrawal. During the adrenalectomy, cardiogenic and vasoplegic shock developed immediately after securing the vascular supply to his tumor. This shock was refractory to vasopressin and methylene blue, but responded well to angiotensin II and epinephrine. After both surgeries were completed, his course was further complicated by severe ICU psychosis, ileus, fungal bacteremia, pneumonia/hypoxic respiratory failure and atrial fibrillation. He ultimately recovered and was discharged from the hospital after 38 days. Conclusion: To our knowledge, this is the first report of surgical AVR and pheochromocytoma resection in a patient with critical aortic stenosis. The appropriate order and timing of surgeries when both these conditions co-exist remains controversial.

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Use of femoral-femoral cardiopulmonary bypass for urgent aortic valve replacement in a patient with critical aortic stenosis and left ventricular dysfunction

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/jcan.2001.24996 ◽

2001 ◽

Vol 15 (4) ◽

pp. 477-479

Author(s):

Deepak K. Tempe ◽

Sangeeta Khanna ◽

Sumir Dubey ◽

M. Nigam

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Critical Aortic Stenosis

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Severe left ventricular dysfunction in critical aortic stenosis--reversal following aortic valve replacement.

Postgraduate Medical Journal ◽

10.1136/pgmj.59.698.781 ◽

1983 ◽

Vol 59 (698) ◽

pp. 781-783 ◽

Cited By ~ 1

Author(s):

D. S. Dymond ◽

F. G. Wolf ◽

D. H. Schmidt

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Severe Left Ventricular Dysfunction ◽

Critical Aortic Stenosis

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Aortic Valve Replacement for Critical Aortic Stenosis After Bilateral Lung Transplantation

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2013.01.022 ◽

2013 ◽

Vol 96 (4) ◽

pp. 1475-1478 ◽

Cited By ~ 1

Author(s):

Trevor Banack ◽

Bulat A. Ziganshin ◽

Paul Barash ◽

John A. Elefteriades

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Lung Transplantation ◽

Valve Replacement ◽

Critical Aortic Stenosis ◽

Bilateral Lung Transplantation ◽

Bilateral Lung

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A national study of the outcome after treatment of critical aortic stenosis in the neonate

Cardiology in the Young ◽

10.1017/s1047951120002036 ◽

2020 ◽

Vol 30 (9) ◽

pp. 1321-1327

Author(s):

Cecilia Kjellberg Olofsson ◽

Katarina Hanseus ◽

Jens Johansson Ramgren ◽

Mats Johansson Synnergren ◽

Jan Sunnegårdh

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

National Study ◽

Term Survival ◽

Critical Aortic Stenosis

AbstractObjective:This study describes short-term and long-term outcome after treatment of critical valvular aortic stenosis in neonates in a national cohort, with surgical valvotomy as first choice intervention.Methods:All neonates in Sweden treated for critical aortic stenosis between 1994 and 2016 were included. Patient files were analysed and cross-checked against the Swedish National Population Registry as of December 2017, giving complete survival data. Diagnosis was confirmed by reviewing echo studies. Critical aortic stenosis was defined as valvular stenosis with duct-dependent systemic circulation or depressed left ventricular function. Primary outcome was all-cause mortality and secondary outcomes were reintervention and aortic valve replacement.Results:Sixty-one patients were identified (50 boys, 11 girls). Primary treatment was surgical valvotomy in 52 neonates and balloon valvotomy in 6. Median age at initial treatment was 5 days (0–26), and median follow-up time was 10.8 years (0.14–22.6). There was no 30-day mortality but four late deaths. Freedom from reintervention was 66%, 61%, 54%, 49%, and 46% at 1, 5, 10, 15, and 20 years, respectively. Median time to reintervention was 3.4 months (4 days to 17.3 years). Valve replacement was performed in 23 patients (38%).Conclusions:Surgical valvotomy is a safe and reliable treatment in these critically ill neonates, with no 30-day mortality and long-term survival of 93% in this national study. At 10 years of age, reintervention was performed in 54% and at end of follow-up 38% had had an aortic valve replacement.

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