二尖瓣修复术后伴人工腱索非内皮化导致严重溶血性贫血和急性肾衰竭：病例报告。

Severe hemolytic anemia and acute renal failure after mitral valve repair associated with non-endothelialization of artificial chordae tendinae: case report.

机构信息

Department of Cardiology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China.

Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China.

出版信息

J Cardiothorac Surg. 2021 Oct 16;16(1):303. doi: 10.1186/s13019-021-01686-6.

DOI:10.1186/s13019-021-01686-6

PMID:34656162

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8520182/

Abstract

BACKGROUND

Mechanical hemolytic anemia and acute renal failure are rare complications of mitral valve repair.

CASE PRESENTATION

We report a unique case of severe hemolytic anemia and severe acute renal failure after mitral valve repair using artificial chordae tendinae. Conservative therapy including plasmapheresis and blood transfusion was not effective. The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. The hemolytic anemia resolved gradually after the replacement of mitral valve. The new artificial chordae tendinae was found to be completely non-endothelialized in the surgery. Non-endothelialization of artificial chordae tendinae may also play a role in the genesis of mechanical anemia.

CONCLUSIONS

The major cause of the mechanical hemolysis was mild mitral regurgitation originating from the centre of the valve and striking the annuloplasty ring. Non-endothelialization of foreign materials might be another mechanism of hemolysis after mitral repair.

摘要

背景

机械性溶血性贫血和急性肾衰竭是二尖瓣修复术罕见的并发症。

病例介绍

我们报告了一例使用人工腱索修复二尖瓣后发生严重溶血性贫血和严重急性肾衰竭的独特病例。包括血浆置换和输血在内的保守治疗无效。机械性溶血的主要原因是源自瓣叶中心的轻度二尖瓣反流，并撞击瓣环成形环。换瓣后溶血性贫血逐渐缓解。手术中发现新的人工腱索完全没有内皮化。人工腱索的非内皮化也可能在机械性贫血的发病机制中起作用。