Thrombotic microangiopathy in a very young infant with mitral valvuloplasty

Matsunaga, Yuka; Ishimura, Masataka; Nagata, Hazumu; Uike, Kiyoshi; Kinjo, Tadamune; Ochiai, Masayuki; Yamamura, Kenichiro; Takada, Hidetoshi; Tanoue, Yoshihisa; Hayakawa, Masaki; Matsumoto, Masanori; Hara, Toshiro; Ohga, Shouichi

doi:10.1016/j.pedneo.2018.02.002

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…Only one patient suffered a clinical relapse and the authors reported that in addition to cardiac bypass surgery, another potential nidus for developing TMA was recent history of ABO incompatible red blood cell transfusion . Of the two patients requiring other therapy in addition to TPE, one patient who developed TMA after mitral valvuloplasty, underwent repeat valvuloplasty with improvement in TMA symptoms . Another patient who developed TMA after myomectomy received eculizumab and demonstrated a complete response …”

Section: Resultsmentioning

confidence: 99%

“…15 Of the two patients requiring other therapy in addition to TPE, one patient who developed TMA after mitral valvuloplasty, underwent repeat valvuloplasty with improvement in TMA symptoms. 28 Another patient who developed TMA after myomectomy received eculizumab and demonstrated a complete response. 35 Outcomes of the five patients not receiving TMA directed treatment included death in three patients and it was reported that these patients had a delay in diagnosis of TMA.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Cardiovascular surgeries were the most common procedure provoking TMA with coronary artery bypass grafts (CABG) [14][15][16][17][18] or a combination of CABG with another vascular procedure being the second most common. 14,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Of TMAs occurring after abdominal surgery, 26,[31][32][33][34][35][36][37] bowel resection accounted for the most common preceding procedure (n = 6). 17,33,[38][39][40][41][42] In addition, five patients developed TMA following orthopedic procedures.…”

Section: Literature Reviewmentioning

confidence: 99%

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Postsurgical thrombotic microangiopathy: Case series and review of the literature

Sridharan

Hook

Leung

et al. 2019

European J of Haematology

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Objectives Describe the clinical presentation, treatment, and outcomes of postsurgical thrombotic microangiopathy (TMA). Methods In this retrospective study, records of individuals diagnosed with TMA developing within 30 days of a surgical procedure at Mayo Clinic from 2000 to 2016 were reviewed. Available literature regarding postsurgical TMA was comparatively reviewed. Results Twenty patients were diagnosed with TMA developing within 30 (median 6.5, range (1‐28)) days) following a procedure. Preceding procedures included orthopedic (n = 4), vascular (n = 4), abdominal (n = 8), thoracic (n = 2), and other (n = 2). Review of the literature identified 65 patients with postsurgical TMA and cardiovascular procedures were the most common preceding surgery. The majority of patients in the current cohort and literature were treated with therapeutic plasma exchange (TPE). Among the evaluable patients in the current cohort, 100% demonstrated response to TPE; however, 25% required the addition of other therapy including eculizumab to maintain a response 80% of patients in the literature demonstrated a response to TPE. Conclusions Although rare, early recognition and treatment of postsurgical TMA can lead to good outcomes. More research is necessary to determine the underlying pathophysiology and optimal treatment for postsurgical TMA.

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Section: Resultsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Postsurgical thrombotic microangiopathy: Case series and review of the literature

Sridharan

Hook

Leung

et al. 2019

European J of Haematology

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“…Device-related TMA as a secondary TMA could be difficult to diagnose if device implementation was performed years ago. Previous reports have demonstrated that cardiac valve-related TMA can appear soon after cardiac valve surgery [4,5], where it was diagnosed by excluding other TMA possibilities [6]. Here, we report the case of an older woman with a chief complaint of dyspnea and the pathophysiology of secondary TMA.…”

Section: Introductionmentioning

confidence: 85%

Device-Related Thrombotic Microangiopathy in an Elderly Patient With a History of Aortic Surgery

Tanaka¹,

Naito²,

Suehiro³

et al. 2022

Cureus

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Thrombotic microangiopathy (TMA) is caused by several diseases, including infections, congenital and autoimmune diseases, and malignancies, usually requiring admission to intensive care. The primary pathophysiology of TMA is microvascular thrombosis, and its diagnosis is based on the presence of hemolysis, thrombocytopenia, schistocytes in a blood smear, and organ damage. Among secondary TMAs, device-related TMA could be difficult to diagnose if device implementation was performed years ago. We report the case of an 87-year-old woman with a chief complaint of dyspnea diagnosed with device-related TMA. In device-related TMA, thrombogenesis/thrombocytopenia is triggered by hemolysis/fragmented red blood cells. However, in other TMAs, thrombogenesis or thrombocytopenia is preceded by hemolysis and the presence of fragmented red blood cells. Thus, rapid plasma exchange is necessary to address TMA pathogenesis. TMA can be managed in a community hospital if the facility has access to plasma exchange. It is possible to treat complex TMAs even in community hospitals by carefully considering their pathophysiology. Additionally, improving the quality of general practice in community hospitals will allow for more effective diagnosis and treatment of TMAs.

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“…(1) progressive anemia; (2) no history of hemolysis before mitral repair; (3) soy urine after operation; (4) residual mitral regurgitation found by echocardiography. Transthoracic echocardiography and transesophageal echocardiography are important for the diagnosis of mechanical hemolysis after mitral repair [Aoyagi 2007;El Sabbagh 2018;Tsang 2019;Matsunaga 2018].…”

Section: E168mentioning

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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Thrombotic microangiopathy in a very young infant with mitral valvuloplasty

Abstract: The youngest case of post-operative TMA underscores the critical coagulopathy after the first surgical intervention for congenital heart disease.

Cited by 3 publications

References 29 publications

Postsurgical thrombotic microangiopathy: Case series and review of the literature

Postsurgical thrombotic microangiopathy: Case series and review of the literature

Device-Related Thrombotic Microangiopathy in an Elderly Patient With a History of Aortic Surgery

Diagnosis and Treatment of Mechanical Hemolysis after Mitral Repair in Adult

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