Hemolysis induced by PMIVSD occluder

Abstract

Hemolysis related to occluder, prosthetic valve, and prosthetic ring used for mitral valve annuloplasty are not very unusual. However, hemolysis related to transcathetor closure of post-myocardial infarction ventricular septal defect (PMIVSD) is infrequent. A close follow-up for spontaneous resolution with or without blood transfusion has been reported in a few cases. Occasionally, surgical retrieval is unavoidable or lifelong blood transfusion is required if surgery cannot be done because of higher risk. In this illustration, we have showed a close follow-up of a case of hemolysis induced by atrial septal occluder used for VSD closure after myocardial infarction. Despite successful device closure of PMIVSD which is difficult, a close watch is needed for complications like residual leak, device embolization, and hemolysis.

Keywords: Atrial septal occluder (ASO); Hemolysis; Post-myocardial infarction ventricular septal defect (PMIVSD); Transcathetor closure (TCC).

Fig. 1

(A) 2D echo shows a large ventricular defect of size 2.1 cm in middle part of interventricular septum with mid-distal septal aneurysm; (B) Coronary angiogram in right anterior oblique (RAO) view shows critical type B stenosis in the middle part of LAD which was stented and the scene angiogram shows atrial septal occluder (Cardi-O-Fix, 28 mm) across the ventricular septal defect immediately following the TCC; (C) Echo shows a stable and better aligned device plugging the VSD at the end of one-month follow-up; (D) Serial changes in color of urine from 2nd day device closure till the day of discharge.