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(Circulation. 2000;101:695.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Hemolysis After Mitral Valve Repair

R. Parker Ward, MD; Lissa Sugeng, MD; Lynn Weinert, BS; Claudia Korcarz, DVM; Ralph J. Verdino, MD; Kirk T. Spencer, MD; Roberto M. Lang, MD

From the University of Chicago Medical Center, Department of Medicine, Section of Cardiology, Chicago, Ill.

Correspondence to Roberto M. Lang, MD, University of Chicago Medical Center, 5841 S Maryland Ave, MC5084, Chicago, IL 60637. E-mail rlang@medicine.bsd.uchicago.edu

A54-year-old woman, status post–mitral valve repair for severe mitral regurgitation secondary to mitral valve prolapse, was admitted 7 weeks after surgery with shortness of breath and fatigue. Hematological studies revealed a Coomb’s-negative hemolytic anemia with a hematocrit of 17.1%, haptoglobin of <7.9 mg/dL (normal 51 to 192 mg/dL), LDH of 3165 U/L, total bilirubin of 6.8 mg/dL (indirect of 6.1 mg/dL), and a peripheral blood smear demonstrating mechanical hemolysis with schistocytosis and red cell fragmentation (arrows, Figure, A). A transesophageal echocardiogram revealed partial dehiscence of the mitral valve annuloplasty ring (No. 28 Baxter Physio ring) from the native mitral valve annulus (arrow, B). Color Doppler images demonstrate severe regurgitation with fragmentation of the mitral regurgitation (arrow, C) into a valvular jet and a high-velocity para-ring regurgitant jet. 3D echocardiographic images reveal a paravalvular communication (white arrow, D) created by the dehiscence of the annuloplasty ring from the native mitral valve annulus. 3D color Doppler images (with color suppression of the lower-velocity valvular regurgitation) demonstrates the high-velocity para-ring regurgitant jet (white arrow, E).

View larger version (103K): [in this window] [in a new window]   Figure 1. A, Peripheral blood smear revealing schistocytes and red cell fragmentation due to mechanical shearing of red blood cells. B and C, Transverse-plane transesophageal images of mitral valve. B, Partial dehiscence (arrow, B) of annuloplasty ring from native mitral valve annulus. C, Color Doppler imaging reveals fragmentation of regurgitant flow into a valvular and a para-ring regurgitant jet. D, 3D echocardiographic images of mitral valve from LA view demonstrating an area of dehiscence (white arrow) of annuloplasty ring . . . [Full Text of this Article]