Transfusion-requiring haemolytic anaemia after mitral-valve repair

Stoschitzky, Kurt; Starz, Ina; Anelli-Monti, M.; Rigler, B; Bauer, Franz K.; Klein, W.

doi:10.1016/s0140-6736(96)90118-x

Cited by 10 publications

(13 citation statements)

References 2 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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“…1,2 The anaemia caused is often severe exacerbating coexisting symptoms of cardiac dysfunction including fatigue and shortness of breath. The treatment of choice for patients with paravalvular leak is replacement valve surgery.…”

Section: Discussionmentioning

confidence: 99%

Novel uses for recombinant erythropoietin therapy in unlicensed indications

Macartney¹,

Adgey²,

Jones³

et al. 2004

Hematol J

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Clinical uses for recombinant human erythropoietin (rHuEPO) therapy continue to expand. Initial use was in anaemia associated with end-stage renal disease, but more recently there have been many reports of the benefits of erythropoietin in other clinical situations such as cancer-related anaemia. Recombinant erythropoietin reduces the need for blood transfusion and hence exposure to donor blood products as well as improving quality of life. We report four patients who were transfusion dependent, none of whom had licensed indications for the use of recombinant erythropoietin. Two patients had microangiopathic haemolytic anaemia secondary to mechanical valve haemolysis and were unsuitable for any further cardiac intervention. One patient had anaemia of chronic disease and anti-Vel red cell antibodies, making compatible blood transfusions difficult to obtain. The fourth patient had primary thrombocythaemia and developed transfusion-dependent anaemia secondary to myelosuppressive agents. All four patients had a relative deficiency in endogenous erythropoietin levels ranging between 7 and 41 IU/l. After commencing recombinant erythropoietin therapy, all had a response in haemoglobin of at least 1 g/dl with an overall improvement in their quality of life. We conclude that rHuEPO is a very convenient and useful form of treatment in transfusion-dependent anaemia and in some cases beyond the licensed indications.

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“…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. 1 The mechanism of hemolysis observed after mitral valve repair most commonly involves direct collision of the regurgitation jet with an annuloplasty ring and appears to be independent of the severity of mitral regurgitation.…”

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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Transfusion-requiring haemolytic anaemia after mitral-valve repair

Cited by 10 publications

References 2 publications

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

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

Novel uses for recombinant erythropoietin therapy in unlicensed indications

Reduction of Hemolysis Without Reoperation Following Mitral Valve Repair

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