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Case Reports
. 2022 Jun 15;4(12):727-731.
doi: 10.1016/j.jaccas.2022.03.021.

Hemolytic Anemia After Surgical Mitral Valve Repair Treated With Transcatheter Edge-to-Edge Device

Adrià Ruiz-López  1 , Chi-Hion Pedro Li  1 , Pilar Valdovinos  2 , Álvaro Rodríguez  1 , Ana Bonet  1 , Manel Tauron  3 , Carmen Ligero  2 , Xavier Millan  1 , Josep M Alegret  2 , David Viladés  2 , Dabit Arzamendi  1
Affiliations
Case Reports

Hemolytic Anemia After Surgical Mitral Valve Repair Treated With Transcatheter Edge-to-Edge Device

Adrià Ruiz-López et al. JACC Case Rep. .

Abstract

An 80-year-old woman with mitral valve repair failure was admitted with hemolytic anemia secondary to the impact of a regurgitant jet on the annuloplasty ring. Transcatheter repair to treat both mitral regurgitation and hemolysis was favored because of surgical risk. Transcatheter edge-to-edge repair represents an alternative for treating hemolysis associated with mitral regurgitation. (Level of Difficulty: Advanced.).

Keywords: MR, mitral regurgitation; MVRe, [surgical] mitral valve repair; TEER, transcatheter-edge-to-edge repair; hemolysis; mitral valve repair; mitral regurgitation; transcatheter-edge-to-edge repair.

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Conflict of interest statement

Drs Li, Millan, and Arzamendi have reported received proctoring and speaker fees from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Hemolysis Parameter Evolution Temporal evolution of hemolysis parameters related to surgical and percutaneous mitral valve repair. Hb = hemoglobin; TEER = transcatheter edge-to-edge repair.
Figure 2
Figure 2
Mitral Valve Before and After Surgical Repair Transesophageal echocardiographic view of posterior leaflet flail with (A) 2-dimensional and (B) 3imensional images before surgery. (C to E) The same perspectives after surgery repair achieving mild mitral regurgitation (E) at the end of the intervention.
Figure 3
Figure 3
Mitral Regurgitation Causing Hemolysis Mitral regurgitation on admission for hemolysis. Note the broken neochords (arrows) prolapsing into the left atrium in the 3-dimensional mitral valve view with and without color (A, B), as well as in the 2-dimensional image (C) and the eccentric jet directed toward the surgical mitral ring.
Figure 4
Figure 4
Mitral Valve Gradients Before and During TEER Intervention bpm = beats per minute; grad = gradient; max V = maximum velocity; MV = mitral valve; PHT = pressure half-time; TEER = transcatheter edge-to-edge repair.
Figure 5
Figure 5
Transcatheter Mitral Valve Repair The transcatheter edge-to-edge repair procedure, (A) starting with the transcatheter edge-to-edge repair “grasping view” and the capture or residual mitral prolapse, (B) with final mild regurgitation and (C) significant improvement of pulmonary vein hemodynamics (top, an inverted S-wave; bottom, a recovered profile). (D and E) 3-dimensional imaging showing the final result.
See this image and copyright information in PMC

References

    1. Abourjaili G., Torbey E., Alsaghir T., Olkovski Y., Costantino T. Hemolytic anemia following mitral valve repair: a case presentation and literature review. Exp Clin Cardiol. 2012;17(4):248–250. - PMC - PubMed
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    1. Sanchis L., Jorda P., Pereda D., et al. MitraClip implantation for hemolytic anemia treatment after surgical mitral valve repair. J Am Coll Cardiol Intv. 2020;13(9):e85–e86. - PubMed

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