Concomitant coronary artery bypass grafting and adrenalectomy for pheochromocytoma.

We report the first case of concomitant coronary artery bypass grafting (CABG) and adrenalectomy for pheochromocytoma. Which lesion to correct first and staging of the corrective procedures are highly controversial issues. Issues concerning pre- and intraoperative control of hemodynamic instability from catecholamine release are discussed. Preoperative alpha and beta blockade permitted excellent hemodynamic control in the operating room. Operative and postoperative courses were uneventful and the patient had complete resolution of his angina and hypertension. We conclude that concomitant CABG and adrenalectomy is the preferred approach when pheochromocytoma and symptomatic coronary artery atherosclerosis coexist.

Use of venous fistula technique for intraoperative cardiac hemorrhage.

We describe an innovative technique to control hemorrhage after right atrial wall reconstruction in a patient with primary angiosarcoma. At the time of surgery, the tumor was found to involve all of the free wall of the right atrium and a superficial layer of the right ventricle. A pericardial patch was used to reconstruct the right atrial wall; however, there was diffuse coagulopathy with bleeding from the anastomoses and remaining tumor. To tamponade the bleeding, a Dacron patch was sewn to the right edge of the pericardium, around the right ventricle and right coronary artery, but with little improvement in the bleeding. A type of Cabrol fistula was then formed with a tube graft from the Dacron patch to the left innominate vein. This acted as a conduit back into the venous system, with the blood taking the path of least resistance. Hemostasis was then achieved, allowing the patient to be taken to the intensive care unit.