Perioperative Management of Pheochromocytoma and Catecholamine-Induced Dilated Cardiomyopathy in a Pediatric Patient

Dilated cardiomyopathy resulting from pheochromocytoma-mediated catecholamine excess poses a unique challenge to heart failure management. Although early screening of patients with familial neoplastic syndromes at risk for pheochromocytoma may facilitate early resection, the resultant manifestations of prolonged catecholamine excess among patients with undiagnosed pheochromocytoma may lead to myocardial fibrosis with both systolic and diastolic dysfunction. Furthermore, the hemodynamic effects of catecholamine excess exacerbate the risks of perioperative hemodynamic instability in the setting of such myocardial depression. This report describes an approach to the perioperative care of a child who had pheochromocytoma and catecholamine-induced cardiomyopathy with ventricular dysfunction refractory to medical management.