[Skip to Content]
[Skip to Content Landing]
Article
November 1966

Intravascular Hemolytic Syndrome Following Aortic Valve Replacement: Complete Hematologic and Cardiac Recovery Without Surgical Intervention

Author Affiliations
BOSTON
From the Richard C. Curtis Hematology Laboratory and the Department of Medicine, Peter Bent Brigham Hospital, and the Department of Medicine, Harvard Medical School, Boston.
Arch Intern Med. 1966;118(5):486-490. doi:10.1001/archinte.1966.00290170074013
Abstract

INTRAVASCULAR hemolytic anemia and bizarre red blood cell fragmentation has been an infrequent but spectacular complication of open heart surgery. More specifically, this syndrome has occurred in association with defective intracardiac prosthetic implants, both interatrial patch grafts 1-7 and valve prostheses.7-16

Of the 15 patients with well-documented "traumatic" hemolytic anemia following aortic valve replacement, only two instances of complete hematologic recovery have been noted, both of which attended replacement of the defective prosthesis.8 Excluding five deaths, the remaining eight patients all showed evidence of persistent hemolytic anemia or a compensated hemolytic state, ie, reticulocytosis, red blood cell (RBC) fragmentation, and a shortened RBC life span (Table).

We have recently studied a patient who developed intravascular hemolytic anemia following implantation of an aortic cagedball valve prosthesis. Although the hematologic features of his illness were similar to previously reported cases, the ultimate course of the hemolytic process was unique in that

References
1.
Neill, C.A., et al: Hemolytic Anemia Following Surgical Repair of Endocardial Cushion Defects, read before the 31st Annual Meeting of Society for Pediatric Research Program, Atlantic City, NJ, May 4, 1961.
2.
Sayed, H.M., et al:  Hemolytic Anemia of Mechanical Origin After Open Heart Surgery ,  Thorax 16:356, 1961.Crossref
3.
Sigler, A.T., et al:  Severe Intravascular Hemolysis Following Surgical Repair of Endocardial Cushion Defects ,  Amer J Med 35:467, 1963.Crossref
4.
Verdon, T.A.; Forrester, R.H.; and Crosby, W.H.:  Hemolytic Anemia After Open-Heart Repair of Ostium-Primum Defects ,  New Eng J Med 269:444, 1963.Crossref
5.
Furuhjelm, U., et al:  Hemolytic Anemia After Repair of Ostium Primum Defect ,  Nord Med 72:1446, 1964.
6.
Sanyl, S.K., et al:  Spontaneous Partial Remission of Post-operative Hemolytic Anemia in a Case With Ostium Primum Defect ,  Circulation 30:803, 1964.Crossref
7.
Sears, D.A., and Crosby, W.H.:  Intravascular Hemolysis Due to Intracardiac Prosthetic Devices ,  Amer J Med 39:341, 1965.Crossref
8.
DeCesare, W.; Rath, C.; and Hufnagel, C.:  Hemolytic Anemia of Mechanical Origin With Aortic Valve Prosthesis ,  New Eng J Med 272:1045, 1965.Crossref
9.
Gehrmann, G., and Loogan, F.:  Mechanical Hemolytic Anemia After Aortic Valve Replacement ,  German Med Month 9:441, 1964.
10.
Viner, E.D., and Frost, J.W.:  Hemolytic Anemia Due to a Defective Teflon Aortic Valve Prosthesis ,  Ann Intern Med 63:295, 1965.Crossref
11.
Yeh, T.J.; Ellison, R.G.; and Wright, C.:  Hemolytic Anemia Due to a Ruptured Prosthetic Aortic Cusp ,  J Thorac Cardiov Surg 49:963, 1965.
12.
Reed, W.A., and Dunn, M.:  Fatal Hemolysis Following Ball Valve Replacement of the Aortic Valve ,  J Thorac Cardiov Surg 48:436, 1964.
13.
Marsh, G.W.:  Intravascular Hemolytic Anemia After Aortic Valve Replacement ,  Lancet 2:986, 1964.Crossref
14.
Stevenson, T.D., and Baker, H.J.:  Hemolytic Anemia Following Insertion of Starr-Edwards Valve Prosthesis ,  Lancet 2:982, 1964.Crossref
15.
Dittman, W.A., and McIlvanie, S.K.:  Hemolytic Anemia Associated With Cardiac Valvular Prostheses, abstracted ,  Clin Res 13:99, 1965.
16.
Reynolds, R.D.; Coltman, C.A., Jr.; and Roberts, D.K.:  Sideropenic Intravascular Hemolysis Due to Prosthetic Valve Insufficiency, abstracted ,  Clin Res 13:281, 1965.
17.
Lewis, K.B., et al:  The Natural History of Teflon Aortic Valve Leaflets, abstracted ,  Clin Res 12:188, 1964.
18.
Braunwald, N.S., and Morrow, A.G.:  A Late Evaluation of Flexible Prostheses Utilized for Total Aortic Valve Replacement ,  J Thorac Cardiov Surg 49:485, 1965.
19.
Kreel, I., et al:  A Syndrome Following Total Body Perfusion ,  Surg Gynec Obstet 111:217, 1960.
20.
Brodeur, M.T.H., et al:  Red Blood Survival in Patients With Aortic Valvular Disease and Ball-Valve Prostheses ,  Circulation 32:570, 1965.Crossref
21.
Dennis, E.W., et al:  The Pattern of Red Blood Survival After Prosthetic Ball Valve Replacement ,  Cardiov Res Cent Bull 3:62, 1964.
22.
Yacoub, M.H.; Rogers, K.; and Taylor, P.C.:  Red Cell Survival in Patients With Aortic Valve Disease ,  Thorax 20:367, 1965.Crossref
23.
 Case Records of the Massachusetts General Hospital (Case 52-1964) ,  New Eng J Med 271:898, 1964.Crossref
×