Acute Autoimmune Cardiomyopathy in Primary Antiphospholipid Antibody Syndrome

Nagappan, Ramesh; Lodge, R S

doi:10.1177/0310057x0203000219

Cited by 4 publications

(3 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fulminant myocarditis is associated with full recovery in over 90% of the patients who survive the event [ 89 ]. There is one case report of APLS associated postoperative fulminant myocarditis managed with immunosuppressive steroids [ 90 ]. Currently, there is some scientific rationale for adding a statin as adjunctive treatment.…”

Section: Intraoperative Management Of Coagulation: a Crucial Problemmentioning

confidence: 99%

Antiphospholipid syndrome; its implication in cardiovascular diseases: a review

Koniari

Siminelakis

Baikoussis

et al. 2010

J Cardiothorac Surg

View full text Add to dashboard Cite

Antiphospholipid syndrome (APLS) is a rare syndrome mainly characterized by several hyper-coagulable complications and therefore, implicated in the operated cardiac surgery patient. APLS comprises clinical features such as arterial or venous thromboses, valve disease, coronary artery disease, intracardiac thrombus formation, pulmonary hypertension and dilated cardiomyopathy. The most commonly affected valve is the mitral, followed by the aortic and tricuspid valve. For APLS diagnosis essential is the detection of so-called antiphospholipid antibodies (aPL) as anticardiolipin antibodies (aCL) or lupus anticoagulant (LA). Minor alterations in the anticoagulation, infection, and surgical stress may trigger widespread thrombosis. The incidence of thrombosis is highest during the following perioperative periods: preoperatively during the withdrawal of warfarin, postoperatively during the period of hypercoagulability despite warfarin or heparin therapy, or postoperatively before adequate anticoagulation achievement. Cardiac valvular pathology includes irregular thickening of the valve leaflets due to deposition of immune complexes that may lead to vegetations and valve dysfunction; a significant risk factor for stroke. Patients with APLS are at increased risk for thrombosis and adequate anticoagulation is of vital importance during cardiopulmonary bypass (CPB). A successful outcome requires multidisciplinary management in order to prevent thrombotic or bleeding complications and to manage perioperative anticoagulation. More work and reporting on anticoagulation management and adjuvant therapy in patients with APLS during extracorporeal circulation are necessary.

show abstract

Section: Intraoperative Management Of Coagulation: a Crucial Problemmentioning

confidence: 99%

Antiphospholipid syndrome; its implication in cardiovascular diseases: a review

Koniari

Siminelakis

Baikoussis

et al. 2010

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…37 There is one case report of APS associated postoperative fulminant myocarditis managed with immunosuppressive steroids. 38 APS is one of the most commonly acquired hypercoagulable states. Minor alterations in the anticoagulant regime, infection, and surgical insult may trigger widespread thrombosis.…”

Section: Catastrophic Apsmentioning

confidence: 99%

Acute postoperative biventricular failure associated with antiphospholipid antibody syndrome

Dornan

2004

British Journal of Anaesthesia

View full text Add to dashboard Cite

Antiphospholipid syndrome is probably the most common acquired hypercoagulable state, but information on perioperative management is sparse. Minor alterations in anticoagulant therapy, infection, or a surgical insult may trigger widespread thrombosis. The perioperative course of a 31-yr-old woman with primary anticardiolipin antiphospholipid antibody syndrome requiring a mitral valve replacement is described. Postoperatively, she developed acute global biventricular failure requiring extracorporeal membrane oxygenation support and plasmapheresis. The management of anticoagulation and cardiac surgery in this condition is reviewed.

show abstract

“…[31] Acute fulminant myocarditis is another dreaded complication, which can be managed by plasmapharesis, antithrombotic therapy, immunosuppressants or fresh frozen plasma replacement. [5,32,33] Considering the virulent valvular tissue destruction with significant thickening and verrucous vegetations, repair of the native valve is not usually an option. Since these patients are younger and anticoagulation is mandatory, mechanical valves score over bioprosthetic valves as a choice for valve replacement.…”

mentioning

confidence: 99%