Hemolytic anemia after mitral valve repair: a case report

Abstract

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.

Severe hemolytic anemia and acute renal failure after mitral valve repair associated with non-endothelialization of artificial chordae tendinae: case report

“…On the contrary, hemolysis following MVR and annular ring placement is uncommon because there are no moving mechanical parts or prosthetic leaflets [ 6 ]. Mechanisms of hemolysis following MVR that have been suggested include the ‘whiplash motion’ of the residual free-floating chordae tendineae, collision of the regurgitant jet into the prosthetic ring, central jets colliding with the atrial wall, fragmentation of the regurgitant jet by a dehisced annuloplasty ring, nonendothelialization of annuloplasty ring, and rapid acceleration of a jet through a small para-ring channel [ 2 , 3 , 7 – 9 ]. This case is a unique case.…”

Hemolysis Combined with Renal Injury after Mitral Valve Repair

“…The decision of reoperation requires serious consideration, because the rate of mortality and complication is significantly higher in the second operation than in the first [Cardoso 2013]. The indications for the timing and approach of the reoperation need to be studied further.…”

Improving flow-induced hemolysis prediction models.

“…Hemolysis has been observed since the earliest application of intra-cardiac prosthetic material into the body [7][8][9][10]. Although improved knowledge about the dynamics of blood flow, enhanced engineering design of cardiovascular devices and the introduction of more bio-compatible materials have reduced the rate of severe hemolysis [11][12][13], mild hemolysis and sub-hemolytic damage remain clinical concerns for modern mechanical circulatory support (MCS) devices, including cardiopulmonary bypass (CPB), extracorporeal membrane oxygenation (ECMO), percutaneous cardiopulmonary system (PCPS), and left ventricular assist devices (LVAD) [12,[14][15][16][17].…”

“…14 An ellipsoidal model of RBC tank-treading in a pure shear flow with corresponding external shear rate, velocity and pressure, having internal velocity and pressure denoted as ui and pi Embedded in this analytical solution is the internal cytoplasmic pressure (pi) that is solved using a Kelvin-Vogt viscoelastic model for the RBC membrane. Because the mathematics of the solution is extensive, readers are referred to the original article for details[179].…”

“…14 The microchannel placed inside a transparent cover for the burst testBonding coverage and channel qualityBonding coverage is one of the important consideration when dealing with solventbased bonding. Furthermore, a successful bonding procedure must cause the least amount of deformation on the channels and other important structures on the surfaces involved in bonding process.…”