Hemolytic anemia after mitral valve repair: a case report.
Hemolytic anemia after mitral valve repair: a case report.
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DOI：
10.1186/1756-0500-6-165
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发表时间：
2013-04-25
影响因子：
1.8
通讯作者：
Garcia T
中科院分区：
文献类型：
--
作者：
Cardoso C;Cachado P;Garcia T
二尖瓣修复术后溶血性贫血仍然是一种被低估的并发症，因为它是一种罕见的情况，并且文献中描述的病例报告很少。造成溶血的机制最常见的是反流喷射，并且根据超声心动图评估，它似乎与其严重程度无关。仅中度反流喷射的患者可能会出现严重症状。我们介绍了一名 74 岁白人女性的病例，她因中度二尖瓣反流喷射而出现严重溶血性贫血和失代偿性心力衰竭，但认为其严重程度不足以解释这种溶血。在排除溶血性贫血的其他原因以及缺乏临床和实验室改善后，患者接受了机械瓣膜置换术。手术后贫血和心力衰竭症状逐渐缓解。本病例报告表明，即使超声心动图低估或不清楚显示显着改变，对于严重溶血且有心脏手术史的患者，在二尖瓣修复术后诊断溶血性贫血也很重要。全球范围内进行的二尖瓣修复手术数量的增加表明了人们对二尖瓣修复术的兴趣，这增加了溶血性贫血在未来可能会更频繁地出现并成为主要关注点的可能性，特别是对于心脏外科医生而言。
Hemolytic 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. We 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. This 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.