SURGICAL-MANAGEMENT OF CARDIAC PHEOCHROMOCYTOMA - RESECTION VERSUS TRANSPLANTATION

Objective The authors review their experience and that of others who h ave reported cases in the literature on the surgical management of car diac pheochromocytomas. Summary Background Data Cardiac pheochromocyto mas are rare cathecolamine-producing tumors that can be densely adhere nt to myocardium. Because resection can be associated with significant morbidity, we sought to determine the best mode of treatment for thes e difficult tumors. Method The authors reviewed the experience for man agement of cardiac pheochromocytomas in their two institutions and tho se reported in the literature. Follow-up was available for 21 of 26 pa tients up to 9 years after resection. Results Twenty-five patients had reconstruction of the native heart, five (20%) died intraoperatively from hemorrhage, one (4%) died postoperatively from sepsis, three (12% ) sustained myocardial infarction, one (4%) required a mitral valve re placement, and three (12%) had incomplete resections, two of whom subs equently developed metastatic disease and died. One patient, thought t o be a high risk for resection, received an orthotopic heart transplan tation. Conclusions Surgical resection of cardiac pheochromocytomas ca n be performed successfully. However, resection of lesions that aggres sively invade adjacent myocardium is associated with significant morta lity and inadequate control of the neoplasm. Cardiac transplantation s hould be available as an option before embarking on resection, and it should be performed if mandated by intraoperative findings.