Repeat mitral valve repair for haemolysis in children

Weill, Olivia; Peyre, Marianne; Vergnat, Mathieu; Cazavet, Alexandre; Stos, Bertrand; Belli, Emrè; Hascoët, Sébastien; Acar, Philippe

doi:10.1016/j.acvd.2014.09.007

Cited by 6 publications

(3 citation statements)

References 12 publications

(11 reference statements)

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“…The failure of the repair resulting in postoperative valvular leakage or the collision of the regurgitant flow with one of the structures of the valvular apparatus were the reported causative mechanisms of hemolysis; furthermore, the degree of shear stress created by regurgitant jet, rather than the grade of the regurgitation, seems better correlate with the severity of the hemolysis. 6 As regards pediatric literature, only 7 cases have been described [7][8][9][10] (Table 1). All patients, except one with rheumatic heart disease, had congenital MV defects.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review

Restivo¹,

Scalzo

Palermo

2023

Journal of Pediatric Hematology/Oncology

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Hemolytic anemia could be caused by several conditions, depending on intrinsic or extrinsic defects of the erythrocyte. The latter group includes mechanical intravascular hemolysis, generally related to malfunctioning prosthetic heart valves or, rarely, heart valves repair. We describe a case of a child with Down syndrome, who developed hemolytic anemia after mitral valve repair. We observed that this condition is a rare complication in pediatrics, with only 7 cases reported in literature. Mechanical hemolysis should always be considered in the differential diagnosis of a new-onset hemolytic anemia, especially in patients with valvular heart disease, undergoing cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review

Restivo¹,

Scalzo

Palermo

2023

Journal of Pediatric Hematology/Oncology

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“…Most of the literature involve case reports. Insufficient experience of doctors with the diagnosis and treatment of mechanical hemolytic anemia after mitral repair easily leads to misdiagnosis and mistreatment [Rose 1954;Pollet 2008;Cerfolio 1997;Dilip 1992;Weill 2015;Naik 2016]. This study aimed to investigate the diagnosis and treatment of mechanical hemolysis after mitral repair in adults.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Mechanical Hemolysis after Mitral Repair in Adult

Wen

et al. 2021

HSF

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Background: Mitral repair has been widely used in the treatment of secondary mitral lesions in recent years. Hemolytic anemia is known to be a rare complication after mitral repair. This study aimed to investigate the diagnosis and treatment of mechanical hemolysis after mitral repair in adults. Methods: In this retrospective study, we reviewed the medical records of patients undergoing mitral repair complicated with mechanical hemolysis at our institution between August 2006 and May 2020. Results: Twenty-four patients undergoing mitral repair complicated with mechanical hemolysis were included in the study. They were divided into two groups: the reoperation group (patients who underwent reoperation; N = 18) and the conservative treatment group (patients who received symptomatic treatments, including blood transfusion, diuresis, alkalization of urine, liver protection, hemodialysis, and oral metoprolol; N = 6. All patients in the reoperation group underwent mitral valve replacement. There were six hospital deaths, all in the conservative treatment group. Seventeen of eighteen patients (94.4%) completed follow up. Fifteen of seventeen survivors (88.2%) were in NYHA class I and 11.8% (2/17) in NYHA class II at the last time follow up. Conclusions: Hemolysis is a sign of failure of mitral repair. Reoperation is the best choice once the hemolysis has been diagnosed. Reoperation should be carried out as soon as possible.

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“…Intractable mechanical hemolytic anemia (IMHA) following mitral valve surgery has a reported incidence of less than 1% and a reoperation rate of 74% [2][3][4][5]. Though procedural risk factors were reported in both surgery and interventional cardiology [4,[6][7][8][9], patient characteristics and perioperative management during reoperation are rarely discussed.…”

Section: Introductionmentioning

confidence: 99%

Intractable mechanical hemolytic anemia complicating mitral valve surgery: a case series study

Wang

Zhang

Fan

et al. 2020

BMC Cardiovasc Disord

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Background: Intractable, mechanical hemolytic anemia (IMHA) is a rare catastrophic complication following mitral valve surgery. We analyzed patient characteristics and IMHA management by reoperations after mitral valve surgery. Methods: We collected medical records from mitral valve patients requiring reoperation due to IMHA. Inclusion criteria: hemoglobin < 100 g/L; positive hemolysis tests and echocardiography results; and exclusion of other hemolysis causes. Results: Data from 25 IMHA cases included 10 (40%) early onset (1.3 (0.3,3.0) months) and 15 (60%) late onset (120 (24,204) months) cases. Early IMHA etiologies included surgical defects (6, 60%), uncontrolled infection (3, 30%) and Bechet's disease (1, 10%). Late IMHA etiologies included degeneration (13, 87%), new infection (1, 7%) and trauma (1, 7%). There were more mechanical valves (15, 88%) than bio-valves (2, 12%); the main valvular dysfunction was paravalvular leak (16, 64%). IMHA manifestations included jaundice (18, 72%), dark urine (21, 84%), heart failure (16, 64%), acute kidney injury (11, 44%), hepatomegaly (15, 60%), splenomegaly (15, 60%) and pancreatitis (1, 4%). Laboratory results showed decreased hemoglobin (70 ± 14 g/L) and increased bilirubin (72 ± 57 μmol/L), lactate dehydrogenase (2607 ± 2142 IU/L) and creatinine (136 ± 101 μmol/L) levels. Creatinine level negatively correlated with hemoglobin level (B = -3.33, S.E. B = 1.31, Exp(B) = 368.15, P = 0.018). Preoperative medications included iron supplements (20, 80%), erythropoietin (16, 64%) and beta-blocker (22, 88%). Two patients died of cardiac causes before reoperation. The other 23 underwent reoperation with long surgical times (aortic cross clamp 124 ± 50 min, cardiopulmonary bypass 182 ± 69 min) and blood transfusions (red blood cells 6 (6, 8) units, plasma 600 (400,800) ml, platelet 1(0,2) units). Postoperative complications included cardiac dysfunction (5, 22%), arrhythmia (10, 43%), sepsis (6, 26%), pulmonary infection (5, 22%), gastrointestinal bleeding (3, 13%), cerebral hemorrhage (2, 9%), chronic renal dysfunction (1, 4%) and surgical hemorrhage (1, 4%). Five (33%) patients died after reoperation from cardiac dysfunction (3, 60%), septic shock (1, 20%) and self-discharge (1, 20%). Conclusions: IMHA induces severe multi-organ dysfunction, contributing to high mortality. Perioperative management should focus on etiological treatment, organ protection, and blood management.

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Repeat mitral valve repair for haemolysis in children

Abstract: Severe haemolysis is a rare complication that can occur after mitral valve repair in congenital heart disease. All patients underwent successful redo repair and had resolution of haemolysis after surgery. Even if redo surgery is required, iterative mitral repair is possible.

Cited by 6 publications

References 12 publications

Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review

Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review

Diagnosis and Treatment of Mechanical Hemolysis after Mitral Repair in Adult

Intractable mechanical hemolytic anemia complicating mitral valve surgery: a case series study

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