title: Hemolytic anemia caused by aortic flap and inversion of felt strip after ascending aorta replacement.
abstract: BACKGROUND
  Hemolysis related to a kinked prosthetic graft or inner felt strip is a very rare complication after aortic surgery. We describe herein a case of hemolytic anemia that developed due to aortic flap of the dissection and inversion of an inner felt strip that was applied at the proximal anastomosis of a replaced ascending aorta 10 years previously.
  
  
  METHODS
  A 74-year-old woman presented with consistent hemolytic anemia 10 years after replacement of the ascending aorta to treat Stanford type A acute aortic dissection. The cause of hemolysis was attributed to mechanical injury of red blood cells at a site of stenosis caused by aortic flap of the dissection and inversion of the felt strip used for the proximal anastomosis. Repeated resection of the strip and graft replacement of the ascending aorta resolved this problem.
  
  
  CONCLUSIONS
  We considered that blood flow disrupted by a jet of blood at the site of the proximal inner felt strip was the cause of severe hemolysis, we describe rare hemolytic anemia at the site of aortic flap and inverted felt strip after replacement of the ascending aorta.
authors.affiliation: Department of Cardiovascular Surgery, Suwa Red Cross Hospital, 5-11-50 Kogando-ri, Suwa City, Nagano, 392-8510, Japan.|Department of Cardiovascular Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano City, Nagano, 380-8582, Japan. ttakano-ths@umin.ac.jp.
authors.forename: Tamaki
authors.initials: T
authors.lastname: Takano
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000209:etiology / Q000601:surgery*; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D005260:Female; D006801:Humans; D012086:Reoperation
keywords: Aorta replacement; Aortic dissection; Hemolytic anemia