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.