Abstract
Objective
Traumatic intravascular hemolysis has been recognized as a potentially serious problem after heart valve replacement. Chronic subclinical hemolysis in these patients with normally functioning valvular mechanical or biologic prostheses rarely develop decompensated anemia. This prospective study evaluates the presence and severity of hemolysis in patients with normally functioning mitral prosthetic valves.
Methods
In this prospective study 78 patients with normally functioning mitral prosthetic valves were evaluated for hemolysis postoperatively on 7th,30th and 180th days by clinical evaluation, transthoracic echocardiography, hemoglobin, serum lactic dehydrogenase (LDH), and reticulocyte count. Data was statistically analysed with paired t test and variance test.
Results
LDH was elevated in almost all the patients with mechanical valve replacement. None had significant anemia. All the evidence of hemolysis was not observed in any of the recipients. There was no statistically significant difference in the degree of hemolysis among the recipients of various tilting disc valves. There was no significant correlation between the severity of hemolysis and cardiac rhythm or the size of valve. The recipients of bileaflet valve had significantly more severe hemolysis than those of tilting disc valves.
Conclusions
Almost all the recipients of mechanical mitral valves had increased LDH values at the follow up. However none had decompensated anemia during 180 days follow up. Bileaflet valves cause more hemolysis than tilting ones. Recipients of Chitra TTK valve prosthesis showed least hemolysis.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Mecozzi G, Nilano AD, De Carlo M, Sorrentino F, Pratali S, Nardi C, et al. Intravascular hemolysis in patients with new-generation prosthetic heart valves: a prospective study. J Thorac Cardiovasc Surg. 2002; 123:550–56.
Case RB, Ness AT, Sarnoff SJ, Stofilman F Jr. Hemolytic syndrome following the insertion of a Lucite ball valve prosthesis in to the cardiovascular system. Circulation 1956; 13:586–91.
Chang H, Lin FY, Hung CR, Chu SH. Chronic intravascular hemolysis after valvular surgery. J Formos Med Assoc. 1990; 89: 880–86.
Liu JS, Lu PC, Chu SH. Turbulence characteristics downstream of bileaflet aortic valve prostheses. J Biomech Eng. 2000; 122: 118–24.
Ellis JT, Wick TM, Yoganathan AP. Prosthesis-induced hemolysis: mechanisms and quantification of shear stress. J Heart Valve Dis. 1998; 7: 376–86.
Skoularigis J, Essop MR, Skudicky D, Middlemost SJ, Sareli P Frequency and severity of intravascular hemolysis after left-sided cardiac valve replacement with Medtronic Hall and St. Jude Medical prostheses, and influence of prosthetic type, position, size and number. Am J Cardiol. 1993; 71:587–91.
Ismeno G, Renzulli A, Carozza A, De Feo M, Iannuzzi M, Sante P, Cortufo M. Intravascular hemolysis after mitral and aortic valve replacement with different types of mechanical prostheses. Int J Cardiol. 1999; 69:179–83.
Crexells C, Aerichide N, Bonny I, Lepage G, Compeau L. Factors influencing hemolysis in valve prosthesis. Am Heart J 1972; 84: 161–70.
Schluter M, Langenstein BA, Hanrath P, Kremer P, Bleifield W. Assessment of transesophageal pulsed Doppler echocardiography in the detection of mitral regurgitation. Circulation. 1982; 66:784–89.
Daniel LB, Grigg LE, Wiesel RD, Rakowski H. Comparison of transthoracic and transesophageal assessment of prosthetic valve dysfunction. Echocardiography. 1990; 7:83–95.
Garcia MJ, Vandervoort P, Stewart WJ, Lytle BW, Cosgrove DM, Thomas JD, et al. Mechanisms of hemolysis with mitral prosthetic regurgitation. Study using transesophageal echocardiography and fluid dynamic simulation. J Am Coll Cardiol. 1996; 27:399–406.
Mohr-Kahaly S, Kupferwasser I, Erbel R, Oelert H, Meyer J. Regurgitant flow in apparently normal valve prostheses: improved detection and semiquantitative analysis by transesophageal two-dimensional color-coded Doppler echocardiography. J Am Soc Echocardiogr. 1990; 3: 187–95.
Garrison LA, Lamson TC, Deutsch S, Geselowitz DB, Gaumond RP, Tarbell JM. An in-vitro investigation of prosthetic heart valve cavitation in blood. J Heart Valve Dis 1994; S8–22.
Ninomiya M, Yagyu K, Kaneko Y, Kotsuka Y, Takamoto S. Hemolysis after mitral valve replacement with mechnical valve prostheses. Jpn J Thorac Cardiovasc Surg. 2001; 49:230–35
Flachskmpf FA, O'Shea JP, Griffin BP, Guerrero L, Weyman AE, Thomas JD. Patterns of Normal Transvalvular regurgitation in Mechanical valve prostheses. J Am Coll Cardiol; 1991; 18: 1493–98.
Lee C S, Chandran K B, Chen L D. Cavitation dynamics of mechanical heart valve prostheses. Artif. Organs 1994; 18: 758–67.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shivakumaraswamy, T., Mishra, P., Radhakrishnan, B. et al. Intravascular hemolysis in patients with normally functioning mechanical heart valves in mitral position. Indian J Thorac Cardiovasc Surg 22, 215–218 (2006). https://doi.org/10.1007/s12055-006-0005-2
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s12055-006-0005-2