Pheochromocytoma with catecholamine-induced cardiomyopathy: Not an appropriate case for laparoscopic procedure

Abstract

Laparoscopic surgery results in multiple postoperative benefits, allowing for quicker recovery and shorter hospital stay, but this is not a panacea. Catecholamine-induced cardiomyopathy (CIC) is well known in patients with persistently elevated catecholamine levels in the blood. The complex interaction between existing cardiac pathology and laparoscopy associated cardiovascular changes may precipitate heart failure in patients with limited cardiac reserve. We report a diagnosed case of adrenal pheochromocytoma undergoing laparoscopic adrenalectomy. A 2D echocardiography done at the time of presentation demonstrated dilated left ventricle (LV) with global hypokinesia and ejection fraction (EF) of 25% with moderate mitral regurgitation (MR). The patient received phenoxybenzamine, 20 mg TDS; propanolol, 10 mg TDS; ramipril, 2.5 mg OD and Amlodipine, 5 mg BD for medical optimization prior to excision of pheochromocytoma. Echocardiography after the start of medical therapy now showed a normal sized LV with EF of 40% with no regional wall motion abnormality with mild MR. Pneumoperitoneum was created with carbon dioxide. Subsequent to peritoneal insufflation patient developed features of left ventricular failure. The laparoscopy was abandoned and laparotomy was done. The surgery could proceed successfully without major intraoperative and postoperative problems.