Birkbeck James P, Gorton Michael E, Vacek James L
Division of Cardiology, Department of Internal Medicine, University of Kansas Hospital, Kansas City, Kansas 66160, USA.
J Heart Valve Dis. 2005 Nov;14(6):749-51.
Hemolytic anemia after mitral repair and annuloplasty ring placement is very uncommon, and rarely described. The case is presented of a 53-year-old woman who developed severe mitral regurgitation and transfusion-dependent hemolytic anemia following mitral valve repair with a Carpentier-Edwards annuloplasty ring, which included transposition of chordae tendineae from the posterior leaflet to the anterior leaflet. Transesophageal echocardiography suggested that the transposed chordae tethered the anterior leaflet, causing malcoaptation of the leaflets. This resulted in central regurgitation divided by the chordae tendineae, producing two turbulent flow jets causing hemolysis. At reoperation, these chordae were removed and two longer Gortex neochordae to the anterior leaflet were placed with subsequent resolution of the anemia. To the authors' knowledge, this is the first case of hemolytic anemia caused by transposed mitral valve chordae tendineae from the posterior to the anterior leaflet.
二尖瓣修复及置入成形环后发生溶血性贫血非常罕见，鲜有报道。本文介绍了一例53岁女性患者，其在使用Carpentier-Edwards成形环进行二尖瓣修复后出现严重二尖瓣反流及依赖输血的溶血性贫血，修复过程包括将腱索从后叶转移至前叶。经食管超声心动图提示，转移的腱索牵拉前叶，导致瓣叶对合不良。这导致腱索分隔的中央性反流，产生两股湍流喷射，引起溶血。再次手术时，移除这些腱索，并在前叶置入两根更长的Gortex人工腱索，随后贫血症状得到缓解。据作者所知，这是首例因二尖瓣腱索从后叶转移至前叶而导致溶血性贫血的病例。
