Abstract
An 81-year-old woman developed severe hemolytic anemia after aortic valve replacement. The anemia was not caused by paravalvular leakage, as in most cases. Instead, it occurred secondary to left ventricular outflow tract obstruction that had not been seen preoperatively and was induced by afterload reduction following aortic valve replacement. The hemolytic anemia was drug-refractory and finally treated with dual-chamber pacing, as for hypertrophic cardiomyopathy.
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References
Palaez-Dominguez S, Perez-Benitio L, Sanz Moreno J, Garcia Calvo I, Ruiz Morales J, Palomo Brano A. Severe hemolytic anemia in hypertrophic cardiomyopathy. Am Heart J. 1992;124:1082–3.
Kubo T, Kitaoka H, Terauchi Y, Tamura S, Okawa M, Yamasaki N, et al. Hemolytic anemia in a patient with hypertrophic obstructive cardiomyopathy. J Cardiol. 2010;55:125–9.
Aurigemma G, Battista S, Orsinelli D, Sweeney A, Pape L, Cuenoud H. Abnormal left ventricular intracavitary flow acceleration in patients undergoing aortic valve replacement for aortic stenosis. A marker for high postoperative morbidity and mortality. Circulation. 1992;86:926–36.
Bartunek J, Sys SU, Rodrigues AC, van Schuerbeeck E, Mortier L, de Bruyne B. Abnormal systolic intraventricular flow velocities after valve replacement for aortic stenosis. Mechanisms, predictive factors, and prognostic significance. Circulation. 1996;93:712–9.
Bach DS. Subvalvular left ventricular outflow obstruction for patients undergoing aortic valve replacement for aortic stenosis: echocardiographic recognition and identification of patients at risk. J Am Soc Echocardiogr. 2005;18:1155–62.
Kayalar N, Schaff HV, Daly RC, Dearani JA, Park SJ. Concomitant septal myectomy at the time of aortic valve replacement for severe aortic stenosis. Ann Thorac Surg. 2010;89:459–64.
Gersh BJ, Maron BJ, Ro Bonow, Dearani JA, Fifer MA, Link MS, et al. ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guideline. Circulation. 2011;2011(124):e783–831.
Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME, Kieval RS. Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY). Circulation. 1999;99:2927–33.
Ito T, Suwa M, Sakai Y, Hozumi T, Kitaura Y. Usefulness of tissue Doppler imaging for demonstrating altered septal contraction sequence during dual-chamber pacing in obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2005;96:1558–962.
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Fukui, S., Mitsuno, M., Yamamura, M. et al. Left ventricular outflow tract obstruction masked by severe aortic stenosis. Gen Thorac Cardiovasc Surg 65, 160–163 (2017). https://doi.org/10.1007/s11748-015-0586-z
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DOI: https://doi.org/10.1007/s11748-015-0586-z