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Valve Haemolysis

Sam Meadows, Patrick Gordon, Richard Inman
Haemolytic anaemia caused by a paravalvular leak presenting as progressively worsening red urine. Haemoglobinuria was easily mistaken for gross haematuria, resulting in extensive invasive urological investigation that proved to be futile. Further investigation following an emergency admission led to the realisation that intravascular haemolysis secondary to a paravalvular leakâ€"presenting 43 years following metallic valve insertionâ€"was the cause of discoloured urine and newly presenting symptomatic anaemia...
June 19, 2017: BMJ Case Reports
Eirik Tjønnfjord, Øystein A Vengen, Sigbjørn Berentsen, Geir Erland Tjønnfjord
Primary chronic cold agglutinin disease (CAD) is an autoimmune haemolytic anaemia in which a specific bone marrow lymphoproliferative disorder causes production of cold agglutinins (CA). Binding of CA to erythrocyte surface antigens results in a predominantly extravascular haemolysis that is entirely complement dependent. Because of complement activation, exacerbations are common during febrile infections, trauma or major surgery. Involvement of the terminal complement pathway with C5-mediated intravascular haemolysis is probably not prominent in stable disease but is supposed to be of importance in exacerbations following acute phase reaction...
May 9, 2017: BMJ Case Reports
Domenico Paparella, Crescenzia Rotunno, Pietro Guida, Mattia Travascia, Micaela De Palo, Andrea Paradiso, Alessandro Carrozzo, Ruggero Rociola
OBJECTIVES: Minimally invasive valve surgery (MIVS) is associated with improved clinical outcome but longer cardiopulmonary bypass (CPB) time. The aim of the present study is to compare inflammatory and coagulation parameters in patients undergoing minimally invasive or standard valve surgery. METHODS: A prospective non-randomized study was performed enrolling 79 patients undergoing mitral (20 right mini-thoracotomy and 18 standard sternotomy) and aortic valve (20 mini-sternotomy and 21 standard sternotomy) procedures...
August 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Francesca Maria Susin, Stefania Espa, Riccardo Toninato, Stefania Fortini, Giorgio Querzoli
BACKGROUND: Haemodynamic performance of heart valve prosthesis can be defined as its ability to fully open and completely close during the cardiac cycle, neither overloading heart work nor damaging blood particles when passing through the valve. In this perspective, global and local flow parameters, valve dynamics and blood damage safety of the prosthesis, as well as their mutual interactions, have all to be accounted for when assessing the device functionality. Even though all these issues have been and continue to be widely investigated, they are not usually studied through an integrated approach yet, i...
February 16, 2017: Biomedical Engineering Online
Rupesh Kumar
Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is among the most common enzymatic disorders of red blood cells. Cardiac surgeries on this group of individuals are associated with an additional risk in terms of impaired oxygenation, prolonged ventilation and increased risk of haemolysis. These patients have a very low threshold for haemolysis due to oxidative stress. Many commonly used drugs also predispose the individual for haemolysis when they are subjected to surgery. Here we present a known case of G6PD deficient patient with symptoms of breathlessness for the last nine years who was taken for surgery with pre-planned precautionary measures to avoid unnecessary haemolysis...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
T G Poder, J-C Boileau, R Lafrenière, L Thibault, N Carrier, M-J de Grandmont, P Beauregard
BACKGROUND: Although most studies have shown that little haemolysis is induced by infusion pumps, there are some notable exceptions. Only limited data are available on the actual infusion pumps that are most used in hospitals in Quebec and elsewhere, namely, the Infusomat(®) Space (peristaltic), Plum A+™ (piston) and Colleague(®) CXE (shuttle) pumps. METHODS: Haemolysis and potassium levels were compared before and after the use of the three different infusion pumps...
April 2017: Vox Sanguinis
Sam Liao, Benjamin Simpson, Michael Neidlin, Tim A S Kaufmann, Zhiyong Li, Maria A Woodruff, Shaun D Gregory
BACKGROUND: Implantation of a rotary blood pump (RBP) can cause non-physiological flow fields in the left ventricle (LV) which may trigger thrombosis. Different inflow cannula geometry can affect LV flow fields. The aim of this study was to determine the effect of inflow cannula geometry on intraventricular flow under full LV support in a patient specific model. METHODS: Computed tomography angiography imaging of the LV was performed on a RBP candidate to develop a patient-specific model...
December 28, 2016: Biomedical Engineering Online
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
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