Perioperative management of a patient with hereditary angioedema during off-pump coronary artery bypass graft surgery.
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.
Department of Anesthesiology, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA. shickvl@yahoo.com
Vladislav
V
Shick
Vajubhai
V
Sanchala
Kathryn E
KE
McGoldrick
John J
JJ
Tartaglia
John
J
Nelson
Arlen J
AJ
Fleisher
D054179:Angioedemas, Hereditary / Q000175:diagnosis / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D050718:Complement C1 Inhibitor Protein / Q000378:metabolism; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D010949:Plasma
D000925:Anticoagulants; D050718:Complement C1 Inhibitor Protein; D006493:Heparin