Mechanical bridge to recovery in pheochromocytoma myocarditis

Abstract

Professor Stephen Westaby and colleagues describe the case of a patient who presented with cardiogenic shock that swiftly deteriorated to severe heart failure. CT revealed a large adrenal tumor that was subsequently indentified as pheochromocytoma. After the tumor was removed, the patient underwent left ventricular assist device implantation as a bridge to left ventricular recovery. Background. A 27-year-old male presented with exercise-related symptoms of chest tightness, palpitations, breathlessness and severe headache, with occasional nausea, dizziness, and blurred vision. Apart from a family history of coronary artery disease there was no other medical history of note. Investigations. Clinical examination, treadmill exercise test (Bruce protocol), electrocardiography, MRI of the abdomen, blood tests, chest radiography, coronary angiography, two-dimensional echocardiography, transesophageal echocardiography, microscopy of the tumor, 131iodine metaiodobenzylguanidine scan. Diagnosis. Pheochromocytoma myocarditis. Management. Intra-aortic balloon pump, levosimendan and dobutamine infusion, α-blockade with phentolamine, surgical removal of the pheochromocytoma, Levitronix® (Levitronix LLC, Waltham, MA) left ventricular assist device implantation.