Evaluation of hemolysis in patients with prosthetic heart valves

Maraj, Rajiv; Jacobs, Larry E.; Ioli, Alfred; Kotler, Morris N.

doi:10.1002/clc.4960210604

Cited by 55 publications

(25 citation statements)

References 31 publications

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“…One major parameter that needs to be taken into account for the AV hemodynamics is to ensure a negligible regurgitation fraction during diastole to minimize the work of the heart and avoid a high shear stress jet that can induce platelet activation and hemolysis [10, 19, 21, 37]. Appropriate sealing of the leaflets is obtained through a proper aspect ratio or a modified leaflet design.…”

Section: Discussionmentioning

confidence: 99%

Effect of Arched Leaflets and Stent Profile on the Hemodynamics of Tri-Leaflet Flexible Polymeric Heart Valves

2016

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Polymeric heart valves (PHV) can be engineered to serve as alternatives for existing prosthetic valves due to higher durability and hemodynamics similar to bioprosthetic valves. The purpose of this study is to evaluate the effect of geometry on PHVs coaptation and hemodynamic performance. The two geometric factors considered are stent profile and leaflet arch length, which were varied across six valve configurations. Three models were created with height to diameter ratio of 0.6, 0.7, and 0.88. The other three models were designed by altering arch height to stent diameter ratio, to be 0, 0.081, and 0.116. Particle image velocimetry (PIV) experiments were conducted on each PHV to characterize velocity, vorticity, turbulent characteristics, effective orifice area (EOA), and regurgitant fraction. This study revealed that the presence of arches as well as higher stent profile reduced regurgitant flow down to 5%, while peak systole downstream velocity reduced to 58% and Reynolds Shear Stress values reduced 40%. Further, earlier reattachment of the forward flow jet was observed in PHVs with leaflet arches. These findings indicate that although both geometric factors help diminish the commissural gap during diastole, leaflet arches induce a larger jet opening, yielding to earlier flow reattachment and lower energy dissipation.

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Section: Discussionmentioning

confidence: 99%

Effect of Arched Leaflets and Stent Profile on the Hemodynamics of Tri-Leaflet Flexible Polymeric Heart Valves

2016

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“…Elevated levels of LDH, a high degree of red blood cell fragments, high urinary iron concentration, and the need for frequent red blood cell transfusions are markers of greater hemolysis. 24,25 …”

Section: Quantification Of Hemolysismentioning

confidence: 98%

Hemolysis Associated With Prosthetic Heart Valves

Shapira¹,

Vaturi²,

Sagie³

2009

Cardiology in Review

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Hemolysis is one of the potentially serious complications of prosthetic heart valves. It is usually associated with either structural deterioration or paravalvular leak. Mild, compensated hemolysis associated with mechanical heart valves is not uncommon even in the current era. Severe hemolysis is rare, however, and usually reflects paravalvular leak. The use of transesophageal echocardiography-guided operative techniques may help prevent or minimize early postoperative paravalvular leakage. There is a gamut of available therapeutic approaches-medical, transcatheter, and surgical-to this complication and therapy should be tailored to the individual patient. Novel pharmacological agents include erythropoietin and pentoxifylline. Several reports described the feasibility of transcatheter closure of paravalvular leak with coils or devices, but their effect on hemolysis is unpredictable. Surgery remains the treatment of choice in severe cases.

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“…A certain degree of hemolysis after heart valve surgery is relatively common, although it may progress to severe forms with hemolytic anemia and require transfusion support [1]. In these cases, valve structure deterioration or paravalvular leakage usually occurs [2].…”

Section: Introductionmentioning

confidence: 99%

Hemolytic anemia after mitral valve repair: a case report

2013

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BackgroundHemolytic anemia after mitral valve repair is still an underestimated complication because it is a rare condition and there are few described case reports in the literature. The mechanism responsible for hemolysis most commonly involves a regurgitant jet and it appears to be independent of its severity as assessed by echocardiography. Patients may experience severe symptoms with only moderate regurgitant jets.Case presentationWe present a case of a 74-year-old Caucasian female who developed severe hemolytic anemia and decompensated heart failure due to a moderate mitral valve regurgitation jet, but it was not considered severe enough to explain such hemolysis. After exclusion of other causes of hemolytic anemia and the lack of clinical and laboratory improvement, the patient underwent valve replacement with a mechanical valve. Anemia and heart failure symptoms gradually resolved after surgery.ConclusionThis case report indicates the importance of including the diagnosis of hemolytic anemia after mitral valve repair in patients with severe hemolysis and a surgical history of heart surgery, even if echocardiography underestimates or is unclear for showing significant alterations. The interest on mitral valve repair as suggested by the increase in the number of these procedures performed worldwide, raises the possibility that hemolytic anemia could be probably seen more frequently in the future and be a cause of major concern, especially for cardiac surgeons.

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Evaluation of hemolysis in patients with prosthetic heart valves

Cited by 55 publications

References 31 publications

Effect of Arched Leaflets and Stent Profile on the Hemodynamics of Tri-Leaflet Flexible Polymeric Heart Valves

Effect of Arched Leaflets and Stent Profile on the Hemodynamics of Tri-Leaflet Flexible Polymeric Heart Valves

Hemolysis Associated With Prosthetic Heart Valves

Hemolytic anemia after mitral valve repair: a case report

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