title: Severe intravascular hemolysis following mitral valve repair.
abstract: We report two cases of severe intravascular hemolysis (IVH) following mitral valve repair using a Cosgrove-Edwards ring. In both cases, the degree of mitral regurgitation (MR) seen postoperatively worsened significantly compared to intraoperative transesophageal echocardiogram. Both patients required reoperation with mitral valve replacement with immediate resolution of the hemolysis. We hypothesize that the mitral regurgitation in the setting of an inadequate mitral valve repair is responsible for the hemolysis and propose various mechanisms to explain this pathophysiology. Although IVH remains a rare complication following mitral valve repair, possible screening recommendations should be considered for early detection and treatment given the growing number of mitral valve repairs being performed.
authors.affiliation: Department of Cardiology, California Pacific Medical Center, 2100 Webster Street, No. 516, San Francisco, CA 94115, USA.
authors.forename: Truong
authors.initials: T
authors.lastname: Duong
authors.forename: Rahul N
authors.initials: RN
authors.lastname: Khurana
authors.forename: Richard A
authors.initials: RA
authors.lastname: Francoz
mesh_terms: D000208:Acute Disease; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D004562:Electrocardiography; D005260:Female; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D008945:Mitral Valve Prolapse / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D014463:Ultrasonography