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Usefulness of three-dimensional transesophageal echocardiography for diagnosis of hemolytic anemia due to inverted internal felt strip after surgery for aortic dissection

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Abstract

Felt strips are widely used for reinforcement of the aortic stump in surgery for aortic dissection (AD). Postoperative hemolytic anemia (HA) due to an inverted internal felt strip at the aortic stump fixation for AD is extremely rare. A 70-year-old woman underwent ascending aorta replacement for acute type A AD, where both proximal and distal anastomotic sites were reinforced with Teflon felt strips. A week later, macroscopic hematuria and HA emerged. Three-dimensional transesophageal echocardiography (3D-TEE) demonstrated that the proximal inner felt strip turned up and protruded into the aortic inner lumen. At redo surgery, which was performed 2 weeks after the initial surgery, the findings of 3D-TEE were confirmed, and the inverted internal felt strip was replaced with a bovine pericardial strip. The findings of HA disappeared immediately after the second surgery. 3D-TEE is a very informative, valuable modality for accurate diagnosis that leads to a safe surgery.

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Acknowledgements

The authors are grateful to Yoko Motomura for her assistance in manuscript preparation.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, St. Mary’s Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan

    Takeshi Oda, Hiroshi Yasunaga, Yasuyuki Zaima, Akiko Arimura, Shinichi Imai, Ryo Kanamoto, Hayato Fukuda, Eiji Nakamura & Shigeaki Aoyagi

  2. Division of Cardiology, St. Mary’s Hospital, 422 Tsubukuhon-machi, Kurume, Fukuoka, 830-8543, Japan

    Hideki Tashiro

  3. 133-22 Kogashima-machi, Omura, Nagasaki, 856-8561, Japan

    Takeshi Oda

Authors
  1. Takeshi Oda
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  2. Hiroshi Yasunaga
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  3. Yasuyuki Zaima
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  4. Akiko Arimura
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  5. Shinichi Imai
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  6. Ryo Kanamoto
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  7. Hayato Fukuda
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  8. Eiji Nakamura
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  9. Hideki Tashiro
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  10. Shigeaki Aoyagi
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Corresponding author

Correspondence to Takeshi Oda.

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Additional informed consent was obtained from the patient for whom identifying information is included in this article.

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Oda, T., Yasunaga, H., Zaima, Y. et al. Usefulness of three-dimensional transesophageal echocardiography for diagnosis of hemolytic anemia due to inverted internal felt strip after surgery for aortic dissection. J Med Ultrasonics 44, 211–214 (2017). https://doi.org/10.1007/s10396-016-0759-0

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  • DOI: https://doi.org/10.1007/s10396-016-0759-0

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