Perioperative management of a patient with hereditary angioedema during off-pump coronary artery bypass graft surgery.

Abstract

The case of a patient with hereditary angioedema (HAE), a rare, life-threatening disorder caused by reduced activity of the C1 esterase inhibitor, and requiring off-pump coronary artery bypass graft (OP-CABG) surgery, is presented. Perioperative management of patients with HAE who undergo complex cardiac surgical procedures are discussed, including an OP-CABG surgical approach to decrease complement activation, fresh-frozen plasma administration to increase C1 esterase inhibitor activity, and administration of reduced doses of heparin and protamine to minimize heparin-protamine complex formation.

• Authors: Vladislav Shick, Vajubhai Sanchala, Kathryn E McGoldrick, John J Tartaglia, John Nelson, Arlen J Fleisher
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 22 Issue 4 Pg. 282-4 (Jun 2010) ISSN: 1873-4529 [Electronic] United States
• PMID: 20522360 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright (c) 2010 Elsevier Inc. All rights reserved.

Chemical References

• Anticoagulants
• Complement C1 Inhibitor Protein
• Heparin

Topics

• Angioedemas, Hereditary (diagnosis, surgery)
• Anticoagulants (therapeutic use)
• Complement C1 Inhibitor Protein (metabolism)
• Coronary Artery Bypass, Off-Pump (methods)
• Heparin (therapeutic use)
• Humans
• Male
• Middle Aged
• Perioperative Care (methods)
• Plasma