Repeat mitral valve repair for haemolysis in children

Abstract

Background: Severe haemolysis is a rare complication after mitral valve repair in congenital heart disease.

Aim: We describe four children with severe mitral regurgitation who underwent valve repair and subsequently developed profound haemolytic anaemia.

Methods: Clinical, echocardiographic and surgical data were collected retrospectively from a surgical centre in France during a 5-year period.

Results: Two patients had atrioventricular septal defects, one patient had congenital mitral dysplasia and one had anomalous left coronary artery from the pulmonary artery with mitral regurgitation. Haemolysis was diagnosed 20 to 75 days after surgery, as a result of clinical and biological examination; it was severe, and blood transfusion support was necessary in all cases. Haemolysis was always associated with eccentric mitral regurgitation with a variable degree of severity (from low to severe). After exclusion of other haemolysis aetiology, redo mitral repair surgery was performed successfully in all cases. The haemolysis was considered to be mechanical in origin, caused by regurgitation of blood through the residual mitral regurgitation and stitches.

Conclusion: Severe haemolysis is a rare complication that can occur after mitral valve repair in congenital heart disease. All patients underwent successful redo repair and had resolution of haemolysis after surgery. Even if redo surgery is required, iterative mitral repair is possible.

Keywords: CHD valve; Cardiopathie congénitale; Mitral valve repair; Reoperation; Réopération; Valvuloplastie.