[Atrial Septal Defect with Hereditary Deficiency of Antithrombin III]

Area of Science:

• Cardiology
• Hematology
• Anesthesiology

Background:

• Hereditary antithrombin III deficiency poses challenges for anticoagulation management during surgery.
• Atrial septal defect (ASD) closure requires careful perioperative planning, especially in patients with thrombophilia.
• Long-term warfarin use for deep vein thrombosis necessitates a bridging strategy for surgical procedures.

Observation:

• A 41-year-old female with hereditary antithrombin III deficiency and ASD was managed preoperatively by discontinuing warfarin and initiating heparin infusion with antithrombin supplementation.
• Antithrombin activity was maintained above 80% during the ASD closure procedure, which utilized standard cardiopulmonary bypass and heparin.
• Postoperatively, heparin infusion continued with antithrombin until the international normalized ratio (INR) normalized with warfarin.

Findings:

• The patient experienced no intraoperative or postoperative thromboembolic events.
• Successful closure of the atrial septal defect was achieved.
• The patient was discharged 20 days post-surgery without complications.

Implications:

• This case highlights a successful perioperative anticoagulation management strategy for patients with hereditary antithrombin III deficiency undergoing cardiac surgery.
• Maintaining adequate antithrombin levels is crucial for preventing thromboembolic events in this high-risk population.
• This approach may serve as a valuable reference for managing similar complex cases in clinical practice.