Hemolytic Anemia Caused by Kinking of Dacron Grafts Implanted in Repair of after Aortic Dissection

Abstract

Background: Hemolytic anemia caused by a kinked Dacron graft is a rare complication after repair of acute aortic dissection. We present a case of hemolytic anemia due to kinking of previously implanted Dacron graft for ascending aorta dissection treated by surgery and replaced with new Dacron.

Case details: We report a case of postoperative hemolytic anemia with kinking of the graft at the outer graft layer and intra luminal bulging of the inner graft. Postoperative computed tomography showed Dacron graft kinking at the mid part of the graft. Transthoracic echocardiography (TTE) revealed good function of repair aortic valve. Upon the redo midsternotomy, we found moderate kinking of the graft at the outer graft layer and intra luminal bulging of the inner graft. We performed reconstruction of the aortic root with a new Dacron.

Conclusion: The careful literature review showed that there are some few cases of hemolytic anemia after dissection, but no cases in which hemolytic anemia occurred in a patient with kinked Dacron graft after surgery delete treated by replacement of kinked Dacron graft by new one.

Keywords: Aortic graft kinking; Hemolytic anemia; Surgical repaired aortic dissection.

Figure 1

(A) Shows dissected aneurysm of the ascending aorta. (B) Shows resection of mid portion of Dacron graft. (C) Shows primary step in reconstruction of aortic root be composite graft. (D) Shows reconstructed of kinked Dacron tube that was wrapped by surrounding tissue for controlling of bleeding from dissected pulmonary artery and previous fibrotic tissue around the old Dacron tube. (E) Shows final reconstruction of aneurysm by bentall operation. Bleeding from surrounding tissue of right coronary artery stump was controlled by 5/0 pledgeted sutures that showed by transverse arrow.

Figure 1

(A) Shows dissected aneurysm of the ascending aorta. (B) Shows resection of mid portion of Dacron graft. (C) Shows primary step in reconstruction of aortic root be composite graft. (D) Shows reconstructed of kinked Dacron tube that was wrapped by surrounding tissue for controlling of bleeding from dissected pulmonary artery and previous fibrotic tissue around the old Dacron tube. (E) Shows final reconstruction of aneurysm by bentall operation. Bleeding from surrounding tissue of right coronary artery stump was controlled by 5/0 pledgeted sutures that showed by transverse arrow.

Figure 2

(A) Shows preoperative schematic image of twisted Dacron tube (black arrow). (B) Shows internal bulging of Dacron graft as result of torsion (black arrow).