November 29, 2025
Background: Vasoplegia is characterized by low systemic vascular resistance despite normal to high cardiac output and can result from various conditions, including cardiac surgery. If untreated, it may progress to vasoplegic shock.
Case Presentation: A man in his 70s with multiple risk factors, including a left ventricular ejection fraction of 35%, developed vasoplegia after taking lisinopril on the day of his elective coronary artery bypass graft (CABG) surgery. Despite initial treatment with vasopressors, his condition required postponement of the planned CABG. In the intensive care unit, he was stabilized with a combination of vasopressin, epinephrine, norepinephrine, and hydrocortisone. Vasoplegia was subsequently treated with hydroxocobalamin, resulting in significant clinical improvement. The patient later underwent successful CABG after discontinuing preoperative angiotensin-converting enzyme (ACE) inhibitor therapy.
Conclusions: This case highlights the potential role of hydroxocobalamin as an effective treatment for vasoplegia, particularly in patients who develop vasoplegic shock after preoperative ACE inhibitor use during cardiac surgery.
Keywords: coronary artery bypass graft; hydroxocobalamin; vasoplegic shock.
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