title: Usefulness of three-dimensional transesophageal echocardiography for diagnosis of hemolytic anemia due to inverted internal felt strip after surgery for aortic dissection.
abstract: Felt strips are widely used for reinforcement of the aortic stump in surgery for aortic dissection (AD). Postoperative hemolytic anemia (HA) due to an inverted internal felt strip at the aortic stump fixation for AD is extremely rare. A 70-year-old woman underwent ascending aorta replacement for acute type A AD, where both proximal and distal anastomotic sites were reinforced with Teflon felt strips. A week later, macroscopic hematuria and HA emerged. Three-dimensional transesophageal echocardiography (3D-TEE) demonstrated that the proximal inner felt strip turned up and protruded into the aortic inner lumen. At redo surgery, which was performed 2 weeks after the initial surgery, the findings of 3D-TEE were confirmed, and the inverted internal felt strip was replaced with a bovine pericardial strip. The findings of HA disappeared immediately after the second surgery. 3D-TEE is a very informative, valuable modality for accurate diagnosis that leads to a safe surgery.
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan. oda@jadecom.jp.|, 133-22 Kogashima-machi, Omura, Nagasaki, 856-8561, Japan. oda@jadecom.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Oda
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasunaga
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Zaima
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Arimura
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Imai
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kanamoto
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Fukuda
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Tashiro
authors.affiliation: Division of Cardiovascular Surgery, St. Mary's Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan.
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Aoyagi
mesh_terms: D000368:Aged; D000743:Anemia, Hemolytic / Q000000981:diagnostic imaging* / Q000209:etiology; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D006801:Humans; D012086:Reoperation
keywords: Aortic dissection; Felt strip; Hemolytic anemia; Three-dimensional transesophageal echocardiography