Hemolysis after mitral valve repair: a report of five cases and literature review.

BACKGROUND AND AIM OF THE STUDY: Hemolytic anemia is known to be a rare complication after the prosthetic replacement of the mitral valve, especially in the presence of perivalvular leaks, and even more rarely after mitral valve repair. Following repair, certain distinct patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Early echocardiographic recognition of these flow patterns may be important to diagnose the condition and may lead to re-repair or replacement of the valve. METHODS: During the past eight years, mitral valve repair was performed by the present authors in 159 patients, with a prosthetic ring being placed in 130 cases. In five of the patients receiving rings (3.8%) however, intractable hemolytic anemia quickly developed, due to recurrent or residual mitral regurgitation, and this necessitated reoperation. RESULTS: The valve was replaced in all five patients. One patient died from respiratory and renal failure leading to multiorgan failure. The other four patients were followed up and are currently in good health, with no evidence of hemolysis. CONCLUSION: Hemolysis frequently occurs immediately or soon after mitral valve repair, and may even appear in mild regurgitation. Thus, following repair with a prosthetic ring it is essential to clearly visualize the dynamic flow patterns postoperatively with transesophageal echocardiography, focusing especially on probable fragmentation, collision and rapid acceleration jets. These findings may lead the surgeon to revise the repair, or to replace the valve.

[Coronary bypass surgery in octogenarians]. / Dokuzuncu dekatta koroner bypass cerrahisi.

OBJECTIVE: The age of the patients referred for coronary bypass surgery is getting older progressively. Early and late postoperative outcome of octogenarians were evaluated and compared with younger age group in this study. METHODS: Records of 55 patients aged 80 years or older (mean age 82.7 +/- 2.8) among 3834 patients, who had coronary bypass graft procedure, operated between 1995 and 2001 were reviewed retrospectively. RESULTS: There were 39 men (70.9%) and 16 women (29.1%). Three patients had aortic valve replacement, 1 had left ventricular aneurysm repair, 1 had carotid endarterectomy additionally. Atrial fibrillation (21.8%), renal dysfunction (16.4%), and prolonged ventilation (10.9%) were the prominent complications. The hospital mortality rate was 7.27% (4 patients). Kaplan Meier Survival Analysis estimated that at the end of 5 years 83.1 + 5.2% of patients were still alive. CONCLUSION: Coronary bypass operations can be performed in octogenarians with slightly increased but acceptable hospital mortality and longer hospital stay. Early intervention and individual modifications in cardiopulmonary bypass techniques may improve the results in this patient population.

Lipid peroxidation in patients with essential hypertension.

Plasma lipid peroxide levels and the susceptibility of erythrocytes to lipid peroxidation were significantly increased in patients with essential hypertension. Patients with retinopathy had higher lipid peroxide levels compared to those without retinopathy. No change was observed in spontaneous hemolysis test values, an indicator of vitamin E status, and erythrocyte glutathione levels of essential hypertensives compared to normotensives. However, erythrocyte glutathione levels were found to be decreased in patients with retinopathy. These results showed that lipid peroxidation was increased in patients with essential hypertension and that this increase was more pronounced in those with retinopathy.