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Vasoplegia: 2 case reports A case report described two boys, aged 14 years and 17 years, who developed vasoplegia following treatment with candesartancilexetil as prophylaxis for aortopathy associated with Marfan’s syndrome to reduce the risk of aortic aneurysm formation [routes not stated]. Case 1: The 17-year-old boy with Marfan’s syndrome was diagnosed with a dilated aortic root with trivial aortic regurgitation. He had been receiving candesartan cilexetil [candesartan] 8mg every morning as prophylaxis for aortopathy associated with Marfan’s syndrome to reduce the risk of aortic aneurysm formation. He took candesartan cilexetil on the day of valve-sparing aortic root replacement surgery also. He had gas induction for anaesthesia and maintenance using sevoflurane. He had a combination of antegrade-retrograde intermittent cold blood cardioplegia instituted and the cardiopulmonary bypass was maintained at normothermia. Normotension was maintained during cardiopulmonary bypass with norepinephrine [noradrenaline]. During the surgery, he received 1.1L of fluid in the form of albumin-human [albumin]. After surgery, he underwent modified ultrafiltration and was transferred to the ICU with a positive fluid balance of 140mL. Postoperatively, he developed severe vasoplegia with a increase in serum lactate, which responded to treatment with norepinephrine. He exhibited no other organ dysfunction and was extubated after 12 hours. He received vasoconstrictor (norepinephrine and milrinone) therapy for 53 hours. Thereafter, he recovered and was discharged home on postoperative day 8. Case 2: The 14-year-old boy who had Marfan’s syndrome with progressive aortic root dilatation, moderate mitral regurgitation and significant pectus carinatum, underwent a valve sparing aortic root replacement, aortic valve repair, mitral valve repair and concomitant Ravitch procedure. He had been receiving candesartan cilexetil [candesartan] 4mg twice a day as prophylaxis for the aortopathy associated with Marfan’s syndrome to reduce the risk of aortic aneurysm formation. He took candesartan cilexetil on the night prior to surgery. He had a combination of antegrade-retrograde intermittent cold blood cardioplegia instituted and the cardiopulmonary bypass was maintained at normothermia. Normotension was maintained during cardiopulmonary bypass with norepinephrine [noradrenaline]. During surgery, he received 1.1L of fluid in the form of albumin-human. During surgery, he also received 970mL of fluid in the form of albumin-human [albumin] and blood products. After surgery, he underwent modified ultrafiltration and was transferred to the ICU with a positive fluid balance of 790mL. Shortly after transfer to the paediatric ICU, he developed profound hypotension due to vasoplegia despite administering human albumin, blood products and increased vasopressor doses. He also required cardiopulmonary resuscitation for 2 minutes. He received inotropic treatment with epinephrine [adrenaline], norepinephrine [noradrenaline], dopamine and vasopressin. Post oper