Treatment strategy of mechanical hemolysis after mitral valve repair
10.16571/j.cnki.1008-8199.2019.03.011
- VernacularTitle: 二尖瓣成形术后并发机械性溶血的治疗策略
- Author:
Xi LIN
1
;
Xiao-wu WANG
1
;
Tao MA
1
;
Bin-bin YUAN
1
;
Ben ZHANG
1
;
Bo YANG
1
;
Zhao-ming LIN
1
;
Wei-da ZHANG
1
Author Information
1. Department of Cardiovascular Surgery,Guangzhou Clinical Medicine College of Navy Medical University / General Hospital of Southern Theatre Command,PLA, Guangzhou 510010,Guangdong,China
- Publication Type:Journal Article
- Keywords:
mitral valve regurgitation;
mitral valve repair;
mitral valve replacement;
mechanical hemolytic anemia;
reoperation treatment
- From:
Journal of Medical Postgraduates
2019;32(3):278-281
- CountryChina
- Language:Chinese
-
Abstract:
Objective In recent yaers, mitral valve repair has been widely used in the surgical treatment of congenital and secondary mitral valve lesions. To investigate the mechanism and treatment strategy of mechanical hemolysis after mitral valve repair. Methods A total of 451 consecutive patients registrated in general hospital of southern theatre command who underwent mitral valve repair surgery between August 2010 and June 2018,of whom 16(3.5%) had complicated mechanical hemolysis(hemoglobinuria, jaundice, anemia), were retrospectively analyzed. Echocardiographic examination showed that there were 3 cases of mild mitral regurgitation(MR), 9 cases of moderate MR and 4 cases of severe MR, among which 75% of mitral regurgitation flow were rapid regurgitant jets (Vmax>4m/s). According to the treatment strategy,all cases were divided into two groups: the aggressive reoperation group（n=10）,patients received re-repair procedures within 1 week after hemolysis diagnosis. The conservative treatment group(n=6), patients received symptomatic treatment of hemodialysis, blood transfusion, diuresis, alkalization of urine, liver protection and oral metoprolol et al. All patients were followed up for 2 to 36 months, with an average (16±7.5) months, and the postoperative echocardiographic results, hemolysis symptom improvement and cardiac function were compared. Results No death occurred in the two groups after operation. The symptoms of patients in the aggressive reoperation group receded rapidly and discharged from hospital. 4 patients in the conservative treatment group received reoperation 3~11 weeks after surgery due to poor treatment effect (1 patient underwent re-repair and 3 patients underwent replacement), the other 2 patients received long-term conservative treatment. The cardiac function of the patients undergoing reoperation was maintained at level I~II. Echocardiographic examination showed that mild MR(n=10), mild~moderate MR(n=3), and no recurrence of mechanical hemolysis. Two patients with long-term conservative treatment, mild~moderate anemia, urinogen +~++, moderate MR, cardiac function at level II, were in a subclinical hemolytic state. Conclusion Mechanical hemolysis frequently occurs immediately or soon after mitral valve repair. Hemoglobinuria, jaundice, anemia and postoper echocardiography found the mitral regurgitant flow with high-shear stress, these helpful to the diagnosis. Surgery is an important factor affecting hemolysis. Hemolysis can be a sign of surgical failure, re-repair operation is the best treatment as soon as possible after the hemolysis has been diagnosed.Conservative treatment is not the priority choice.
