title: Management of type A aortic dissection and a large pheochromocytoma: a surgical dilemma.
abstract: The concomitant presence of an undiagnosed pheochromocytoma at the time of an acute type A aortic dissection creates a difficult management dilemma. The case of a patient with an acute type A aortic dissection and pheochromocytoma was stabilized with catecholamine blockade before undergoing ascending aortic and total arch replacement. Fourteen days later the patient underwent resection of the pheochromocytoma. Temporizing medical stabilization of the pheochromocytoma with catecholamine blockade for a period of 5 days allowed for safe aortic reconstruction and seems to be prudent, provided that the aortic dissection remains relatively stable.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. bowenf@uphs.upenn.edu
authors.forename: Frank W
authors.initials: FW
authors.lastname: Bowen
authors.forename: Jessie
authors.initials: J
authors.lastname: Civan
authors.forename: Anton
authors.initials: A
authors.lastname: Orlin
authors.forename: Thomas
authors.initials: T
authors.lastname: Gleason
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000768:Anesthesia, General / Q000009:adverse effects; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001027:Aortography; D001281:Atrial Fibrillation / Q000601:surgery; D006328:Cardiac Catheterization; D002395:Catecholamines / Q000378:metabolism; D017115:Catheter Ablation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D004630:Emergencies; D006406:Hematoma / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology; D033162:Incidental Findings; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D010643:Phenoxybenzamine / Q000627:therapeutic use; D010673:Pheochromocytoma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D012186:Retroperitoneal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D002395:Catecholamines; D010643:Phenoxybenzamine; D008790:Metoprolol