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Valve Haemolysis

Maurizio Taramasso, Francesco Maisano, Alberto Pozzoli, Ottavio Alfieri, Bernhard Meier, Fabian Nietlispach
The incidence of paravalvular leaks after surgical valve replacement is estimated to be 2-17%. Paravalvular leaks (PVL) can be asymptomatic and not require treatment or can cause haemolysis or heart failure. If symptomatic or if the severity of the leak is moderate or severe, redo surgery is a therapeutic option, but this is accompanied by a high perioperative risk and a high recurrence rate. A lower risk alternative is percutaneous PVL closure, with a 1-2% risk of periprocedural death or need for reoperation...
May 17, 2016: EuroIntervention
Fabian Nietlispach, Francesco Maisano, Paul Sorajja, Martin B Leon, Charanjit Rihal, Ted Feldman
Paravalvular leak (PVL) occurs after both surgical and transcatheter valve replacement/implantation. It can lead to haemolysis, heart failure and may increase the risk of endocarditis. Percutaneous closure has significantly less morbidity than re-operation and is therefore often the therapy of choice. Percutaneous PVL closure can make an important difference for patients and can improve patient prognosis. These procedures can be intricate and larger case series and research is needed to further develop and improve these procedures...
December 14, 2016: European Heart Journal
A De Bruyn, P Dendale, E Benit
Paravalvular leak is a common complication after surgical mitral valve replacement. Surgically implanted prosthetic valves are complicated with paravalvular leaks in 17%.(1) Surgical closure of paravalvular leaks is the most common therapy for these defects. Percutaneous closure is an alternative to repeat surgery for a selected high-risk population. We present a case of a patient who developed severe haemolytic anaemia and secondary renal failure after partially successful percutaneous closure of paravalvular leakage of a prosthetic mitral valve...
February 3, 2016: Acta Clinica Belgica
Mohammed G Al-Azawy, A Turan, A Revell
A detailed Computational Fluid Dynamics (CFD) study of transient, turbulent blood flow through a positive displacement left ventricular assist device (LVAD) is performed. Two common models for Non-Newtonian blood flow are compared to the Newtonian model to investigate their impact on predicted levels of shear rate and wall shear stress. Given that both parameters are directly relevant to the evaluation of risk from thrombus and haemolysis, there is a need to assess the sensitivity to modelling non-Newtonian flow effects within a pulsatile turbulent flow, in order to identify levels of uncertainly in CFD...
February 26, 2016: International Journal for Numerical Methods in Biomedical Engineering
James P Curtain, James William O'Brien
A 62-year-old man presented to his general practitioner with a 10-day history of dark red urine. Subsequent blood tests revealed an acute kidney injury and anaemia. His only medical history was a prosthetic mitral valve replacement 30 years previously for rheumatic valve disease. Following referral to a urology service, initial investigations, including CT KUB (kidneys, ureters, bladder), excluded a urological cause for his presentation. A haemolysis screen was positive. A transthoracic echocardiogram reported severe aortic stenosis and aortic incompetence...
January 20, 2016: BMJ Case Reports
Radwa Bedair, Gareth J Morgan, Vinayak Bapat, Stamatis Kapetanakis, Sebastian Goreczny, John Simpson, Shakeel A Qureshi
AIMS: We sought to evaluate the feasibility and efficacy of hybrid transapical closure of paravalvar mitral leaks using a new Occlutech PLD occluder in patients with heart failure and/or haemolytic anaemia. METHODS AND RESULTS: Retrospective analysis of clinical and procedural data was undertaken for patients who had attempted closure of paravalvar mitral leaks via a hybrid transapical approach with the Occlutech PLD occluder. Eight patients (four males, median age 69 years) underwent closure of 10 mitral paravalvar leaks using eight Occlutech PLD occluders and two AMPLATZER Vascular Plugs (AVP II)...
December 10, 2016: EuroIntervention
Muhammad A Soofi, Maya T Ignaszewski, Thomas H Ashton, Robert T Miyagishima
The Bjork Shiley valve (BSV) is considered as the pioneer among modern disc valves, and eventually evolved into a reliable prosthesis after considerable research and multiple modifications. Various case reports have been published with follow-up of different types of BSV. We are reporting the longest follow-up ever published of a plano-convex type of BSV. Our patient's valve was implanted in 1973 due to a congenital bicuspid aortic valve with concomitant severe, symptomatic aortic stenosis, discovered at the age of 27...
March 2016: Interactive Cardiovascular and Thoracic Surgery
Wytze J Vermeijden, Johanna Am Hagenaars, Thomas Wl Scheeren, Adrianus J de Vries
OBJECTIVES: Does additional postoperative collection and processing of mediastinal shed blood with a cell salvage device reduce the number of allogeneic blood transfusions compared to intraoperative cell salvage alone? METHODS: A single-centre cohort study in which adult patients with coronary artery bypass grafting or aortic valve replacement were allocated to either a C.A.T.S(®) group with intraoperative blood processing only or a CardioPat(®) group with both intra- and postoperative blood processing...
July 2016: Perfusion
Nayef M Kazzaz, Patrick Coit, Emily E Lewis, W Joseph McCune, Amr H Sawalha, Jason S Knight
OBJECTIVES: While diffuse alveolar haemorrhage (DAH) is recognised as a life-threatening complication of systemic lupus erythematosus (SLE), little is known about its risk factors and response to treatment. We describe 22 cases of DAH in a US lupus cohort of approximately 1000 patients, and compare them to 66 controls from the same outpatient cohort. METHODS: We captured variables pertaining to diagnoses of SLE and secondary antiphospholipid syndrome (APS), and analysed them by univariate testing...
2015: Lupus Science & Medicine
Ewa Klusak, Alessandro Bellofiore, Sarah Loughnane, Nathan J Quinlan
In flow through cardiovascular implants, hemolysis, and thrombosis may be initiated by nonphysiological shear stress on blood elements. To enhance understanding of the small-scale flow structures that stimulate cellular responses, and ultimately to design devices for reduced blood damage, it is necessary to study the flow-field at high spatial and temporal resolution. In this work, we investigate flow in the reverse leakage jet from the hinge of a bileaflet mechanical heart valve (BMHV). Scaled-up model hinges are employed, enabling measurement of the flow-field at effective spatial resolution of 167 μm and temporal resolution of 594 μs using two-component particle image velocimetry (PIV)...
November 2015: Journal of Biomechanical Engineering
Mohammed G Al-Azawy, A Turan, A Revell
Computational fluid dynamics (CFD) is applied to study the unsteady flow inside a pulsatile pump left ventricular assist device, in order to assess the sensitivity to a range of commonly used turbulence models. Levels of strain and wall shear stress are directly relevant to the evaluation of risk from haemolysis and thrombosis, and thus understanding the sensitivity to these turbulence models is important in the assessment of uncertainty in CFD predictions. The study focuses on a positive displacement or pulsatile pump, and the CFD model includes valves and moving pusher plate...
February 2016: Computer Methods in Biomechanics and Biomedical Engineering
Olivia Weill, Marianne Peyre, Mathieu Vergnat, Alexandre Cazavet, Bertrand Stos, Emre Belli, Sébastien Hascoet, Philippe Acar
BACKGROUND: Severe haemolysis is a rare complication after mitral valve repair in congenital heart disease. AIM: 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...
February 2015: Archives of Cardiovascular Diseases
Chad Kliger, Ahmed Al-Badri, Sean Wilson, Dillon Weiss, Vladimir Jelnin, Itzhak Kronzon, Gila Perk, Gregory P Fontana, Carlos E Ruiz
AIMS: Transcatheter techniques can theoretically be applied to the treatment of para-annular ring (PAR) leaks. Little is known about their potential application and resultant complications in such cases. We describe the first-in-man percutaneous transapical-transseptal Melody valve-in-ring (ViR) implantation after a complication from percutaneous PAR leak closure. METHODS AND RESULTS: A 49-year-old woman, at high operative risk, presented with congestive heart failure secondary to severe para-ring/extravalvular regurgitation two months after bypass surgery and mitral ring annuloplasty...
December 2014: EuroIntervention
Herko Grubitzsch, Shaohua Wang, Klaus Matschke, Mattia Glauber, David Heimansohn, Erwin Tan, Katrien Francois, Markus Thalmann
OBJECTIVES: The Freedom SOLO™ valve (Sorin Group, Italy) is a stentless aortic bioprosthesis designed for simplified implantation. The present multicentre study is the largest prospective evaluation of this prosthesis. Herein, we report on outcomes at 3-year follow-up. METHODS: From March 2009 to February 2013, a total of 804 consecutive patients (mean age 74.9 ± 6.3 years; 45.1% females) underwent aortic valve replacement with the Freedom SOLO™ valve at 33 centres...
March 2015: European Journal of Cardio-thoracic Surgery
Daisuke Yoshioka, Koichi Toda, Yasushi Yoshikawa, Yoshiki Sawa
We report the successful longest biventricular support using dual Jarvik 2000 biventricular assist device (BVAD; Jarvik Heart, Inc., New York, NY, USA) as a bridge to transplant. A 27-year old woman with arrhythmogenic right ventricular cardiomyopathy underwent implantation of two Jarvik 2000s as a left ventricular assist device and right ventricular assist device. Although several BVAD-related complications including haemolysis, hepatic dysfunction, heart failure and pulmonary valve insufficiency developed at a very late stage, she was successfully bridged to heart transplantation after 1245 days of biventricular support, which is the longest in the literature...
December 2014: Interactive Cardiovascular and Thoracic Surgery
Haruna Araki, Tadashi Kitamura, Tetsuya Horai, Ko Shibata, Kagami Miyaji
OBJECTIVES: The elephant trunk technique for aortic dissection is useful for reducing false lumen pressure; however, a folded vascular prosthesis inside the aorta can cause haemolysis. The purpose of this study was to investigate whether an elephant trunk in a small-calibre lumen can cause haemolysis. METHODS: Inpatient and outpatient records were retrospectively reviewed. RESULTS: Two cases of haemolytic anaemia after aortic surgery using the elephant trunk technique were identified from 2011 to 2013...
December 2014: Interactive Cardiovascular and Thoracic Surgery
Giuseppe Santoro, Giancarlo Scognamiglio, Gianpiero Gaio, Carola Iacono, Luca Giugno, Maria G Russo
A 56-year-old patient was referred because of refractory heart failure and mild haemolysis caused by multiple, severe paravalvular leaks of a Starr-Edwards valve implanted in mitral position 23 years before. Owing to perceived high risk of surgical re-valving, percutaneous paravalvular leak occlusion was performed by implantation of multiple, simultaneously deployed Amplatzer Vascular Plugs.
June 28, 2014: Journal of Cardiovascular Medicine
Eiki Tayama, Yukihiro Tomita, Ken-ichi Imasaka, Takanori Kono
A 75-year-old man (Asian, Japanese) was readmitted for examination of a heart murmur and haemolytic anemia 3 months after mitral valve and tricuspid annuloplasties and coronary artery bypass. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract and extending to the right atrium, a small defect between the left ventricle and the right atrium. No periprosthetic leaks were found in the mitral position. We judged that surgical repair of the defect was essential to treat mechanical haemolysis...
June 18, 2014: Journal of Cardiothoracic Surgery
Brian Beckord, Robert Berkowitz, Cholene Espinoza, Neil Anand
Severe haemolytic anaemia is a rare complication of prosthetic valve thrombosis (PVT). Emergent surgical replacement of the affected valve is normally the treatment of choice unless contraindicated, such as in high surgical risk patients. Systemic thrombolysis is the alternative to surgical valve replacement. The purpose of this report is to highlight the unique case of an elderly man with New York Heart Association class IV heart failure, history of extensive cardiopulmonary surgeries and haemorrhagic stroke, who presented with severe haemolytic anaemia secondary to prosthetic mitral valve thrombosis...
2014: BMJ Case Reports
Maurizio Taramasso, Francesco Maisano, Azeem Latib, Paolo Denti, Andrea Guidotti, Alessandro Sticchi, Vasileios Panoulas, Gennaro Giustino, Alberto Pozzoli, Nicola Buzzatti, Linda Cota, Michele De Bonis, Matteo Montorfano, Alessandro Castiglioni, Andrea Blasio, Giovanni La Canna, Antonio Colombo, Ottavio Alfieri
OBJECTIVES: Paravalvular leaks (PVL) occur in up to 17% of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience. METHODS: From October 2000 to June 2013, 139 patients with PVL were treated in our Institution...
October 2014: European Heart Journal Cardiovascular Imaging
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