A Case of Prolonged Angioedema After Cardiac Surgery

Angioedema (AE) is a transient capillary leak syndrome, caused by either histamine or bradykinin, that presents as an acute nonpitting swelling of the skin, subcutaneous tissues, and mucous membranes of the face, lips, tongue, upper airways, and gastrointestinal tract, with or without a rash. A lack...

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Bibliographic Details
Published in:Journal of cardiothoracic and vascular anesthesia 2020-07, Vol.34 (7), p.1890-1896
Main Authors: Mukhdomi, Taif, Maslow, Andrew, Joyce, Maurice F.
Format: Article
Language:English
Subjects:
Aged
angioedema
Angioedema - chemically induced
Angioedema - diagnosis
angiotensin converting enzyme inhibitor
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Bradykinin
C1 esterase inhibitor
Cardiac Surgical Procedures - adverse effects
Complement C1 Inhibitor Protein
Female
Humans
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Summary:Angioedema (AE) is a transient capillary leak syndrome, caused by either histamine or bradykinin, that presents as an acute nonpitting swelling of the skin, subcutaneous tissues, and mucous membranes of the face, lips, tongue, upper airways, and gastrointestinal tract, with or without a rash. A lack of response to antihistamines, steroids, and epinephrine suggests a bradykinin-mediated AE. Bradykinin-AE may be inherited, acquired, or drug related. Mechanism of increased bradykinin can include decreased C1-esterase inhibitor (C1-INH) levels or activity, increased bradykinin production, or decreased bradykinin breakdown, the latter occurring during angiotensin converting enzyme inhibitor (ACEi). A 65-year-old woman had coronary artery bypass grafting, which was complicated by prolonged bradykinin-AE owing to ACEi, requiring prolonged endotracheal tube intubation. Treatment with a C1-esterase inhibitor (Berinert) on postoperative day 7 resulted in a dramatic improvement in airway edema and tongue swelling within 7 hours, and the patient was subsequently extubated. The case is unusual because of the prolonged course of AE and the benefit of late administration of C1-INH concentrate.
ISSN:1053-0770
1532-8422
DOI:10.1053/j.jvca.2019.12.025