Mechanical haemolytic anaemia after valve repair operations for non-rheumatic mitral regurgitation.

Warnes, Carole A.; Honey, M; Brooks, N; Davies, JE; Gorman, April R.; Parker, Noor Mohamed

doi:10.1136/hrt.44.4.381

Cited by 15 publications

(8 citation statements)

References 23 publications

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“…In addition, mitral regurgitant (MR) jet collision with a pledget, the atrial wall, or the annuloplasty ring can cause hemolysis [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Reoperation after mitral valve repair in viewpoints of kidney injury as well as hemolytic anemia

Ishida¹,

Adachi²,

Shiotsu³

et al. 2014

CEN Case Rep

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“…In addition, mitral regurgitant (MR) jet collision with a pledget, the atrial wall, or the annuloplasty ring can cause hemolysis [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Reoperation after mitral valve repair in viewpoints of kidney injury as well as hemolytic anemia

Ishida¹,

Adachi²,

Shiotsu³

et al. 2014

CEN Case Rep

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“…Only 7 patients among 1,548 who had underwent mitral valve repair needed reoperation for hemolytic anemia. 4 The mechanisms of hemolysis following mitral valve repair have been reported to include dehisced annuloplasty rings producing para-ring regurgitant jets, 3,8,11 protruding perivalvular suture material that provided a site of impact for circulating RBCs, 7,9,13 'whiplash motion' of residual, free-floating chordae tendineae within a hyperkinetic left ventricular chamber, 10 nonendothelialization of foreign materials such as sutures or rings 6 and a small but turbulent regurgitation jet against the left atrial wall. 5 Rapid acceleration, fragmentation and collision jets are associated with high shear stress, and may cause mitral prosthetic hemolysis, whereas free and slow deceleration jets are not.…”

Section: Discussionmentioning

confidence: 99%

“…12 On the other hand, an improvement in the hemolytic anemia following reoperation has been reported in many cases. [2][3][4][5][6][7][8][9][10][11] Because of the severe hemolysis requiring a blood transfusion, we recommended that our patient undergo reoperation, but unexpectedly, the hemolysis reduced without reoperation, although a moderate mitral regurgitation jet remained. Slowed velocity caused by propranolol may reduce the shearing stress between RBCs and foreign material, 14 but in this case, the hemolysis was reduced without an apparent change in velocity or blood pressure.…”

Section: Discussionmentioning

confidence: 99%

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Reduction of Hemolysis Without Reoperation Following Mitral Valve Repair

Inoue

Kaku

Kanaya

et al. 2003

Circ J

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emolytic anemia is uncommon after mitral valve repair and only a few cases have been reported. Although it is thought that rapid acceleration, fragmentation and collision of mitral regurgitation jets may be associated with high shear stress and cause hemolysis, 1,2 the precise mechanisms are not understood. In addition, the course of severe hemolysis after mitral valve repair has not been established, although in most cases the hemolysis improves with reoperation. [2][3][4][5][6][7][8][9][10][11] We report a patient who developed a severe hemolytic anemia after mitral valve repair that was reduced without the need for reoperation. Case ReportA 60-year-old man suffered from shortness of breath because of severe mitral regurgitation secondary to the prolapse of the posterior mitral leaflet. Transthoracic echocardiography revealed severe mitral regurgitation filling the whole left atrium from the medial scallop of the posterior mitral leaflet. The dimension of the left atrium in systole phase and the left ventricle in diastole was 53 mm and 58 mm, respectively. Surgery was performed under cardiopulmonary bypass, in mild hypothermia. Myocardial protection was afforded with cold crystalloid cardioplegia. A left paraseptal atriotomy was performed. The prolapsing medial scallop of the posterior mitral leaflet was resected, and the edge of leaflet was sewn onto a mitral annulus. A Duran flexible ring was sutured and fixed along the mitral Circulation Journal Vol.67, September 2003 annulus. A water injection test confirmed no regurgitation. Transthoracic echocardiography 10 days after the mitral valve repair showed mild mitral regurgitation, reaching the deep left atrium from the posterior mitral commissure. The dimension of the left atrium in systole and the left ventricle in diastole was 34 mm and 45 mm, respectively. Three weeks after the mitral valve repair, the patient was discharged with no complaints. After 2 months, he was readmitted complaining of fatigue and shortness of breath. His palpebral conjunctivae were anemic and bulbar conjunctivae icteric, but splenomegaly was not apparent. Laboratory data were as follows: red blood cell (RBC): 206×10 4 / l; hemoglobin: 6.2 g/dl; haptoglobin: <10 mg/dl; reticulocytes: 15.6×10 4 / l; lactate dehydrogenase (LDH): 3,235 IU/L; total bilirubin: 1.6 mg/dl. All these values had been within the normal range 5 months earlier. The Donath-Landsteiner test, Coombs test, Ham test and sugar water test were all negative. Drug-induced hemolytic anemia was not apparent, because there was no reduction of hemolysis after stopping the administration of any drug without furosemide, which was administered before the mitral valve repair. The

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“…Early case reports on hemolysis after mitral valve repair with sutures highlighted the crucial role of foreign material in the path of turbulent flow in causing hemolysis. 5 Later reports of hemolytic anemia in patients who had annuloplasty rings demonstrated areas of poor endothelialization on the annuloplasty ring caused by residual regurgitant jets. 6 Early postoperative MR prevents endothelialization of annuloplasty rings and predisposes to hemolytic anemia.…”

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confidence: 99%