Factors influencing hemolysis in valve prosthesis |
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| Authors: | C Crexells N Aerichide Y Bonny G Lepage L Campeau |
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| Affiliation: | 1. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;2. Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;3. Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;1. Division of Cardiology, MedStar Washington/Georgetown University Hospital Center, Washington, DC, USA;2. Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA;3. Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA;4. Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA;5. Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA;1. The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York;2. Departments of Medicine and Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada;3. Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California |
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| Abstract: | Hemolysis was found in 67.3 per cent of 208 patients with valve prosthesis. The diagnosis of hemolysis was based on an increased serum lactic dehydrogenase activity (SLDH) with sub-unit liver/heart < 0.8 in 114 patients. In the others, it was determined by increased serum hydroxybutiryl dehydrogenase (HBD), free plasma hemoglobin, and abnormally high reticulocyte count. Excellent correlations existed between SLDH and HBD plasma levels on the one hand, and between SLDH levels and free plasma hemoglobin on the other. Significant hemolytic anemia (hemoglobin < 10.5 Gm. per 100 ml.) was observed in only 5 per cent of these patients, irrespective of iron replacement therapy. The Beall mitral prosthesis was found the most prone to hemolysis, a complication observed in all 12 cases studied. The Starr-Edwards Stellite ball Teflon-covered valve hemolyzes significantly more than the silicone elastomer ball uncovered prosthesis in the aortic and mitral positions. It is felt that the Teflon covering may be an important hemolytic factor in both Starr-Edwards model and Beall prostheses. |
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