title: Repeat mitral valve repair for haemolysis in children.
abstract: BACKGROUND
  Severe haemolysis is a rare complication after mitral valve repair in congenital heart disease.
  
  
  OBJECTIVE
  We describe four children with severe mitral regurgitation who underwent valve repair and subsequently developed profound haemolytic anaemia.
  
  
  METHODS
  Clinical, echocardiographic and surgical data were collected retrospectively from a surgical centre in France during a 5-year period.
  
  
  RESULTS
  Two patients had atrioventricular septal defects, one patient had congenital mitral dysplasia and one had anomalous left coronary artery from the pulmonary artery with mitral regurgitation. Haemolysis was diagnosed 20 to 75 days after surgery, as a result of clinical and biological examination; it was severe, and blood transfusion support was necessary in all cases. Haemolysis was always associated with eccentric mitral regurgitation with a variable degree of severity (from low to severe). After exclusion of other haemolysis aetiology, redo mitral repair surgery was performed successfully in all cases. The haemolysis was considered to be mechanical in origin, caused by regurgitation of blood through the residual mitral regurgitation and stitches.
  
  
  CONCLUSIONS
  Severe haemolysis is a rare complication that can occur after mitral valve repair in congenital heart disease. All patients underwent successful redo repair and had resolution of haemolysis after surgery. Even if redo surgery is required, iterative mitral repair is possible.
authors: Toulouse University Hospital, M3C, Paediatric Cardiology Unit, Toulouse, France. Electronic address: weill.olivia@gmail.com.
authors: Olivia
authors: O
authors: Weill
authors: Toulouse University Hospital, M3C, Paediatric Cardiology Unit, Toulouse, France.
authors: Marianne
authors: M
authors: Peyre
authors: Centre Chirurgical Marie-Lannelongue-M3C, Department of Paediatric and Congenital Heart Disease, Paris-Sud University, France.
authors: Mathieu
authors: M
authors: Vergnat
authors: Toulouse University Hospital, M3C, Paediatric Cardiology Unit, Toulouse, France.
authors: Alexandre
authors: A
authors: Cazavet
authors: Centre Chirurgical Marie-Lannelongue-M3C, Department of Paediatric and Congenital Heart Disease, Paris-Sud University, France.
authors: Bertrand
authors: B
authors: Stos
authors: Centre Chirurgical Marie-Lannelongue-M3C, Department of Paediatric and Congenital Heart Disease, Paris-Sud University, France.
authors: Emre
authors: E
authors: Belli
authors: Toulouse University Hospital, M3C, Paediatric Cardiology Unit, Toulouse, France.
authors: Sébastien
authors: S
authors: Hascoet
authors: Toulouse University Hospital, M3C, Paediatric Cardiology Unit, Toulouse, France.
authors: Philippe
authors: P
authors: Acar
mesh_terms: D000743:Anemia, Hemolytic / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital; D006461:Hemolysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation
keywords: CHD valve; Cardiopathie congénitale; Mitral valve repair; Reoperation; Réopération; Valvuloplastie