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Sunil K. Bhudia
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Ann Thorac Surg 2005;79:754-755
© 2005 The Society of Thoracic Surgeons

Correspondence

Hemolysis Caused by Regurgitant Blood Flow With High Shear Stress: An Intractable Complication After Mitral Valve Repair: Reply

Buu-Khanh Lam, MD

Division of Cardiac Surgery University of Ottawa Heart Institute, 40 Ruskin St, Room H3404, Ottawa, on K1Y 4W7, Canada

Delos M. Cosgrove, III, MD, Sunil K. Bhudia, BS, MRCS, A. Marc Gillinov, MD

Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk 725, Cleveland, Oh 44195, USA

bklam{at}ottawaheart.ca

To the Editor:

We thank Drs Oki and Misawa for their comments on our study [1]. The case report they presented serves to illustrate three important points that we have observed in our experience. first, the early occurrence of persistent anemia and hemolysis after mitral valve repair should always raise suspicion about the mitral procedure just performed. the mild residual regurgitation observed on echocardiography was unlikely to be related to the postoperative myocardial infarction, and this was confirmed by the residual anterior leaflet prolapse seen at reoperation. second, in their patient, a relatively small regurgitant volume led to hemolysis as a result of the combination of two commonly observed mechanisms of hemolysis—fragmentation and collision. this may have led to high shear stress conditions in the absence of high-volume or high-velocity regurgitant jets. this is, however, an uncommon scenario. third, this case report reemphasizes the finding that hemolysis is a mode of failure of mitral valve repair that can be treated successfully by mitral valve replacement.


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  1. Lam B-K, Cosgrove DM III, Bhudia SK, Gillinov AM. Hemolysis after mitral valve repair: mechanisms and treatment. Ann Thorac Surg. 2004;77:191–195[Abstract/Free Full Text]




This Article
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Delos M. Cosgrove, III
Sunil K. Bhudia
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Right arrow Valve disease

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