Hemolytic anemia due to paravalvular leakage after valve replacement: its clinical course and an indication for reoperation
Ina, H.; Kawazoe, K.; Kasegawa, H.; Kozakai, Y.; Kaku, K.; Obara, K.; Tomino, T.; Kito, Y.; Fujita, T.
Nihon Kyobu Geka Gakkai 34(6): 823-828
1986
ISSN/ISBN: 0369-4739 PMID: 3760625 Document Number: 285695
Paravalvular leakage after valve replacement sometimes gives birth to severe hemolytic anemia. We experienced paravalvular leakage in sixteen of 587 patients who had valve replacement from August, 1977 to December, 1983. Paravalvular leakage was diagnosed by two dimensional Doppler echocardiography. Nine Ionescu-Shiley valves, six Bjork-shiley valves and one Hancock pericardial valve were used in these sixteen cases. Seven cases evolved hemolytic anemia due to paravalvular leakage after surgery (Hb < 10.5 g/dl). In three of these seven, serum LDH rose rapidly over 1500 IU/L and medical treatments were uneffective in hemolytic anemia. They needed massive blood transfusion to correct anemia and postoperative Cr clearance decreased markedly in comparison with the preoperative one (preoperative 40 ml/min/m2, postoperative 11 ml/min/m2). One patient fell in acute renal failure for which peritoneal dialysis was necessitated. All of these three were reoperated to be free from hemolytic anemia. On the other hand, in two of the seven, serum LDH went up to about 1500 IU/L and thereafter decreased gradually. Medical therapy was sufficient to treat anemia and blood transfusion was not necessary in these patients. Their postoperative Cr clearance was nearly same as the preoperative one in contrast to the previous three patients (preoperative 40 ml/min/m2, postoperative 38 ml/min/m2). It is not wise to hesitate reoperation for control of severe hemolysis due to paravalvular leakage, considering their morbidity and risk. We conclude that reoperation should be indicated for a patient with paravalvular leakage, whose serum LDH increases over 1500 IU/L after surgery.