Case report Transpulmonary thermodilution hemodynamic monitoring for pheochromocytoma surgery in a child with complex congenital heart disease IMANE CHERQAOUI MD MD , OLIVIER RAUX MD MD , LAURENCE DEHOUR MD MD , ALAIN ROCHETTE MD MD , CHRISTOPHE DADURE MD MD AND XAVIER CAPDEVILA MD P MD PhD Department of Anesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, and Montpellier School of Medicine, Montpellier, France Summary Hemodynamic alterations related to pheochromocytoma surgery may lead to decompensation with an associated cardiac malformation. Moreover, they are incompletely described in children because of potential hazards of invasive monitoring. We report transpulmonary thermodilution hemodynamic monitoring during pheochromocytoma surgery in a child with a complex congenital heart malformation. Comprehensive analysis of hemodynamic events was obtained that guided therapeutic decisions. Cardiac function was preserved and no complication occurred. Keywords: pheochromocytoma; hemodynamic; monitoring; heart malformation; pediatric; child Introduction Pheochromocytoma is a rare occurrence in children (1), but in combination with congenital heart dis- ease, peroperative hemodynamic management is potentially complicated. Transpulmonary thermo- dilution (TPT) allows cardiac output measurements without intracardiac catheterization. We describe here TPT hemodynamic monitoring and anesthesia management of a child with complex cardiac malformation undergoing removal of pheochromo- cytoma. Case report A 13-year-old boy, 30 kg, with a typical pheo- chromocytoma clinical presentation, was scheduled for surgical removal of two retroperitoneal extra- adrenal tumors. He was known to be affected with cyanotic congenital heart disease, characterized by single ventricle, tricuspid atresia and pulmonary artery stenosis, dysplasic single atrioventricular valve and duplication of superior vena cava. A Blalock–Taussig shunt (aortopulmonary connec- tion), with a diameter of 4 mm, was created when he was 1 year old. At the age of 8 years, a modified Glenn shunt was performed (cavopulmonary anas- tomosis from the double superior vena cava to the left and right pulmonary arteries with conservation of the aortopulmonary shunt). Clinical examination showed no sign of cardiac failure and hemoglobin Correspondence to: Dr Raux, De ´partement d’Anesthe ´sie Re ´anima- tion A, Ho ˆpital Lapeyronie, 371, avenue du doyen Gaston Giraud, 34295 Montpellier Cedex 5, France (email: o-raux@chu- montpellier.fr). Pediatric Anesthesia 2006 16: 1277–1280 doi:10.1111/j.1460-9592.2006.01997.x Ó 2006 The Authors Journal compilation Ó 2006 Blackwell Publishing Ltd 1277