Hemolytic anemia caused by aortic flap and inversion of felt strip after ascending aorta replacement

Abstract

BackgroundsHemolysis related to a kinked prosthetic graft or inner felt strip is a very rare complication after aortic surgery. We describe herein a case of hemolytic anemia that developed due to aortic flap of the dissection and inversion of an inner felt strip that was applied at the proximal anastomosis of a replaced ascending aorta 10 years previously.Case presentationA 74-year-old woman presented with consistent hemolytic anemia 10 years after replacement of the ascending aorta to treat Stanford type A acute aortic dissection. The cause of hemolysis was attributed to mechanical injury of red blood cells at a site of stenosis caused by aortic flap of the dissection and inversion of the felt strip used for the proximal anastomosis. Repeated resection of the strip and graft replacement of the ascending aorta resolved this problem.ConclusionsWe considered that blood flow disrupted by a jet of blood at the site of the proximal inner felt strip was the cause of severe hemolysis, we describe rare hemolytic anemia at the site of aortic flap and inverted felt strip after replacement of the ascending aorta.

Hemolysis following wrap aortoplasty for Type A aortic dissection repair: Case report and review of the literature

“…Some authors have suggested that the most important imaging finding suggestive of mechanical hemolysis secondary to a graft complication is a ‘mosaic pattern’ on echocardiography representative of turbulent blood flow. 26 This finding, when paired with a typical pattern of laboratory values, should increase suspicion for mechanical hemolysis secondary to graft complications and may prompt reoperation to correct a probable defect.…”

“…To date, 30 cases of hemolytic anemia secondary to aortoplasty have been reported in the English literature (Table 2). 6–28 The reported mechanisms included aortic graft stenosis (50%), graft kinking (23%), external compression of the graft (20%), and a folded elephant trunk appendage (7%). Graft stenosis was largely attributed to the inversion of Teflon strips; however, other cases involving implant narrowing secondary to graft dehiscence or dissection flap obstruction at the distal anastomosis have been reported.…”

“…The literature search yielded 23 peer-reviewed case reports and review papers which collectively reported 29 unique cases of hemolysis following aortoplasty for Type A dissection (Table 2). 6–28…”

Simultaneous Aortic Valve-in-Valve and Ascending Stent Grafting for Prosthetic Valve Stenosis and Ascending Flap

“…Hemolysis after aortic surgery has been reported in several studies. 2 , 3 ) Inverted internal felt strips and severely kinked grafts, which cause accelerated flow and mechanical damage to red blood cell, are the main causes of hemolysis. 2 , 3 ) In contrast, significant AS notably reduced hemoglobin and haptoglobin levels and increased LDH levels, 5 ) indicating that AS also potentially causes hemolysis.…”

“…Hemolytic anemia is a rare but possible complication both after aortic valve replacement (AVR) 1 ) and ascending aortic replacement. 2 , 3 ) Reoperative replacement of the aortic valve and the ascending aorta has significant surgical mortality and morbidity, making less invasive approach desirable for high-surgical-risk patients. Here we describe a case of prosthetic aortic valve stenosis and internal bovine pericardial flap in the ascending aorta after surgery for acute aortic dissection complicated by congestive heart failure and hemolytic anemia, which were successfully treated by simultaneous transcatheter aortic valve-in-valve and ascending stent grafting.…”