Torsades de pointes during laparoscopic adrenalectomy of a pheochromocytoma: a case report.

Abstract

INTRODUCTION:

Torsades de pointes is a rare but potentially lethal arrhythmia. The amount of literature available on Torsades de pointes occurring in patients with pheochromocytoma is limited, and we found no literature describing this dysrhythmia in a patient with pheochromocytoma under anesthesia.

CASE PRESENTATION:

We describe the case of a 42-year-old Caucasian woman without QT prolongation preoperatively with recurrent Torsades de pointes during laparoscopic removal of a pheochromocytoma. Torsades de pointes mainly occurs in the setting of a prolonged QT interval. This patient neither had a prolonged QT preoperatively nor was her family history suspect for a congenital long QT syndrome. Most likely, our patient had an acquired long QT syndrome, elicited by the combination of flecainide, hypomagnesemia and adrenergic stimulation during manipulation of the tumor.

CONCLUSION:

We show that in the case of a surgical pheochromocytoma removal, perioperative conditions can elicit an acquired or previously unknown congenital long QT syndrome. Therefore, preoperative α- and β-blockade is advised, QT-prolonging drugs should be avoided and potassium and magnesium plasma levels should be kept at normal to high levels.

• Authors: Kinge van der Heide, Ann de Haes, Götz Jk Wietasch, Ans Cp Wiesfeld, Herman Gd Hendriks
• Journal: Journal of medical case reports (J Med Case Rep) Vol. 5 Pg. 368 (Aug 12 2011) ISSN: 1752-1947 [Electronic] England
• PMID: 21838875 (Publication Type: Journal Article)