title: Severe intravascular hemolysis after aortic valve replacement: reversal by left ventricular apico-abdominal aortic composite conduit.
abstract: Severe intravascular hemolysis developed following aortic valve replacement with a No. 17 Björk-Shiley prosthesis in a patient with a diminutive aortic annulus. At reoperation, a residual gradient of 54 mm. Hg and no evidence of perivalvular leak were found. A second left ventricular outflow tract between the apex and the supraceliac abdominal aorta was fashioned with a special rigid (Pyrolite) prosthesis and a heterograft valved composite conduit. The gradient was reduced to 5 mm. Hg and hemolysis was reversed. We have now created double-outlet left ventricles for primary or recurrent left ventricular outflow tract obstructions of various etiologies in 13 other pediatric and adult patients. The longest follow-up is approaching 18 months. All gradients have been sharply reduced and all patients are asymptomatic.
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000601:surgery*; D001012:Aorta, Abdominal / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000295:instrumentation; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000601:surgery*