Department of Cardiac Surgery, Niguarda Hospital, Milan, Italy.
Department of Hematology, Niguarda Hospital, Milan, Italy.
J Am Coll Cardiol. 2021 May 11;77(18):2323-2334. doi: 10.1016/j.jacc.2021.03.295.
Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approach to diagnosis, and impact of other hematological conditions on the resultant anemia. The importance of a multidisciplinary management is underscored. Laboratory data are provided about subclinical hemolysis that is commonly observed following the implantation of surgical and transcatheter valve prostheses and devices. Finally, clinical scenarios are reviewed and current medical and surgical treatments are discussed, including alternative options for inoperable patients.
机械性血管内溶血在心脏瓣膜手术后经常观察到，而在原发性瓣膜病中不常见。在大多数情况下，其严重程度较轻。然而，它可能具有临床意义，甚至危及生命，需要多次输血和肾脏替代治疗。本文回顾了机械性血管内溶血在瓣膜病中的现有知识，包括术前和术后，重点介绍了病理生理学、诊断方法以及其他血液状况对贫血的影响。强调了多学科管理的重要性。还提供了关于植入外科和经导管瓣膜假体和装置后常见的亚临床溶血的实验室数据。最后，回顾了临床情况并讨论了当前的医疗和手术治疗方法，包括无法手术患者的替代选择。
