Successful management of an infant with hypertensive heart failure associated with Wilms’ tumor: a case report

• Published in: JA clinical reports Vol. 6; no. 1; p. 12
• Main Authors: Miura, Hiroko, Kawana, Shin, Sugino, Shigekazu, Kikuchi, Chika, Yamauchi, Masanori
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 13.02.2020; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesia; Anesthesiology; Blood pressure; Case Report; Case reports; Critical Care Medicine; Emergency Medicine; Heart failure; Hypertension; Intensive; Medicine; Medicine & Public Health; Pain Medicine; Renin-angiotensin-aldosterone system; Wilms’ tumor; Hypertension; Heart failure; Renin-angiotensin-aldosterone system; Wilms’ tumor
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-020-00318-7

Background Wilms’ tumor with hyperreninemia may result in critical cardiovascular decompensation. We report a case of severe hypertensive heart failure followed by tumor resection in a 3-month-old infant with Wilms’ tumor. Case presentation A 3-month-old girl was admitted to the intensive care unit for Wilms’ tumor with hypertension and hypoxia. Her systolic blood pressure was 110 mmHg, and her SpO 2 was 92%. She presented with severe hypertensive heart failure and received mechanical ventilation and antihypertensive therapy for hypertension and heart failure. An alpha 2-adrenergic receptor agonist was used for sedation as part of her antihypertensive therapy. On hospital day 16, nephrectomy with tumor resection was performed under general anesthesia. Her systolic blood pressure did not vary more than 20 mmHg during surgery due to appropriate preoperative management. Hemodynamic collapse did not occur. Conclusions The highlight of this case report is the successful management of an infant with Wilms’ tumor, particularly with respect to preoperative hemodynamic control and sedation.