A case report of mitral valve replacement in a patient with lupus antibody syndrome

Abstract

Systemic lupus erythematosis (SLE) is an autoimmune disease frequently accompanied by the presence of an antiphospholipid antibody (APA). Early referred to as the lupus anticoagulant (LAC), this APA consists of immunoglobulins that are known to interfere with coagulation tests that are phospholipid dependent. Such tests include the partial thromboplastin time (PTT), the activated clotting time (ACT) and may affect the thrombin time (TT). This challenges the cardiac surgical team and the perfusionist responsible for monitoring anticoagulation while performing cardiopulmonary bypass (CPB). A 46-year-old female with a history of SLE, severe mitral insufficiency, an anterior wall myocardial infarction, and the presence of a LAC was admitted for mitral valve surgery. Replacement of the mitral valve was accomplished successfully, utilizing CPB. Anticoagulation was managed using the Hepcon HMS PLUS, a device that calculates an individual's heparin dose response and permits assessment of the heparin concentration throughout the procedure. The patient recovered and was sent home 16 days after surgery.

The antiphospholipid syndrome and heart valve surgery

“…(e) Application of less protamine, e.g. by giving half of the calculated dose or no protamine at all [95,98,99,113,126].…”

A case of acute myocardial infarction during perioperative period of non-cardiac surgery in a patient with antiphospholipid syndrome and a history of coronary artery bypass surgery

“…Some reports show preoperative antithrombotic therapy using enoxaparin or heparin with doubling the baseline aPTT in cardiac surgery for patients with APS [10][11][12]. Intraoperative antithrombotic therapies by heparin have been reported to double the baseline activated coagulation time, to monitor anti-Xa concentration, and heparin concentration in cardiac surgery for patients with APS ( [10][11][12][13][14][15][16][17][18][19][20], Table 1). However, the strategy of antithrombotic therapy during perioperative period of non-cardiac surgery for patients with APS has not been documented in literature.…”

Coagulation management of a patient with factor V Leiden mutation, lupus anticoagulant, and activated protein C resistance: a case report

“…There have been several reports of mitral insufficiency in patients with LA. 13,14 Some investigators have hypothesized that the intrinsic prothrombotic state may increase fibrin deposition along valvular structures, which may be especially evident in patients suffering from endocarditis. 13 The mitral insufficiency was not addressed because the surgeon felt this transitory and reversible, most likely related to the ischemic episode.…”