Acute Crit Care.  2024 Feb;39(1):194-198. 10.4266/acc.2021.01158.

Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report

• Park S
• Kim M
• Lee DI
• Lee JH
• Kim S
• Lee SY
• Bae JW
• Hwang KK
• Kim DW
• Cho MC
• Bae DH

• KMID: 2555240
• DOI: http://doi.org/10.4266/acc.2021.01158

Abstract

The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

Keyword

cardiogenic shock; cardiomyopathy; catecholamine; extra-corporeal membrane oxygenation; pheochromocytoma

Figure

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  Figure 1. (A) Left ventricular end diastolic volume (75.01 ml [1]) on apical four-chamber view. (B) Left ventricular end systolic volume (59.25 ml [2]) on apical four-chamber view. (C) Left ventricular end diastolic volume (61.66 ml [1]) on apical two-chamber view. (D) Left ventricular end systolic volume (55.06 ml & ejection fraction 16% [2]) on apical two-chamber view.

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  Figure 2. (A) Left atrial venting via Brockenbrough needle (HeartSpan; Merit Medical). (B) Right coronary artery and (C) left coronary artery are normal.

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  Figure 3. On L-6-[18F] fluoro-3,4-dihydroxyphenylainine (18F-DOPA) positron emission tomography-computed tomography a 2.4-cm in F-DOPA mass (SUVmax 8.9) (green arrow) was observed in the left adrenal gland.

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