Tomino Mikiko, Miyata Kazuto, Takeshita Yuji, Kaneko Koki, Kanazawa Hiroko, Uchino Hiroyuki
Masui. 2015 Jul;64(7):761-3.
A 54-year-old woman was admitted for mitral valvular repair. After folding plasty to A3, a 30 mm Cosgrove-Edwards ring was placed. There was no mitral regurgitation jet observed by transesophageal echocardiography (TEE) during the operation. However, high blood pressure was monitored and treated in the intensive care unit, hemolytic anemia developed, and the serum lactate dehydrogenase level was elevated. Two weeks after the operation, serum lactate dehydrogenase was again elevated. TEE showed mild mitral regurgitation and the regurgitation jet colliding with the annuloplasty ring. Multiple transfusions of red blood cells were required. Repeat surgery was therefore undertaken. Lam and associates previously studying patients on hemolysis after mitral valvular repair noted high grade mitral regurgitation jets fragmented or accelerated. In the present case, mitral regurgitation was mild, but the high velocity and manner of regurgitation (collision with the annuloplasty ring) could cause hemolytic anemia. In the present case, high blood pressure might have caused chordae rupture. Furthermore, a flexible ring, such as the Cosgrove-Edwards ring, is likely to cause hemolytic anemia. As contributing factors to hemolysis after mitral valvular repair, perioperative blood pressure management and type of ring are significant.
一名54岁女性因二尖瓣修复术入院。对A3进行折叠成形术后，置入了一个30毫米的科斯格罗夫-爱德华兹环。手术过程中经食管超声心动图（TEE）未观察到二尖瓣反流束。然而，在重症监护病房监测到高血压并进行了治疗，随后出现了溶血性贫血，血清乳酸脱氢酶水平升高。术后两周，血清乳酸脱氢酶再次升高。TEE显示轻度二尖瓣反流，反流束与瓣环成形环碰撞。需要多次输注红细胞。因此进行了再次手术。林及其同事之前在研究二尖瓣修复术后溶血的患者时发现，重度二尖瓣反流束破碎或加速。在本病例中，二尖瓣反流为轻度，但反流的高速及方式（与瓣环成形环碰撞）可能导致溶血性贫血。在本病例中，高血压可能导致腱索断裂。此外，像科斯格罗夫-爱德华兹环这样的柔性环可能会导致溶血性贫血。作为二尖瓣修复术后溶血的促成因素，围手术期血压管理和环的类型很重要。
