J Korean Med Sci.  2013 Dec;28(12):1827-1829. 10.3346/jkms.2013.28.12.1827.

Hemolytic Anemia Case Caused by an Inverted Inner Felt after Bentall Operation

• Kang H
• Choe JW
• Cho DY
• Sohn DS
• Kim SW
• Hong J

• KMID: 1779427
• DOI: http://doi.org/10.3346/jkms.2013.28.12.1827

Abstract

A 26-yr-old male patient reported worsened dyspnea, dizziness one year after an emergency Bentall operation for type A aortic dissection. There was evidence of hemolytic anemia and aortogram revealed a significant stenosis at the distal anastomosis site. During the reoperation, we found the inner felt at the distal anastomosis was inverted causing a significant stenosis. The reoperation successfully resolved this problem. Here, we report a rare case of hemolytic anemia caused by an inverted inner felt after Bentall operation.

Keyword

Anemia, Hemolytic; Aortic Dissection; Inverted Felt

MeSH Terms

Acute Disease
Adult
Anastomosis, Surgical
Anemia, Hemolytic/*diagnosis/*etiology/surgery
Aneurysm, Dissecting/complications/*surgery
Aortic Aneurysm/complications/*surgery
*Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation/*adverse effects/instrumentation
Dizziness/etiology
Dyspnea/etiology
Echocardiography
Humans
Male
*Postoperative Complications/surgery
Reoperation
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 CT taken two days after the surgery. No significant stenosis at the distal anastomosis site.

• 

  Fig. 2 Aortogram taken one year after surgery. Narrowing of the aorta anastomosis site.

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  Fig. 3 Inverted inner felt (arrows indicate the most significant inversion). (A) Operative field after the aorta transsection. (B) Resected felt strips. (C) Schematic view.

Reference

1. Bedetti CD, Siewers RD, Dunsford HA. Teflon felt embolism of coronary arteries after cardiac surgery: a case report. Am Heart J. 1978; 96:802–805.

2. Sogawa M, Moro H, Namura O, Ishiyama T, Hayashi J. Thrombus on the intraluminal felt strip: a possible cause of postoperative stroke. Jpn J Thorac Cardiovasc Surg. 2001; 49:333–335.

3. Hata M, Yoshitake I, Wakui S, Unosawa S, Hata H, Shiono M. Postoperative early hemolytic anemia due to inverted teflon felt strip after emergency repair for type A dissection. Thorac Cardiovasc Surg. 2011; 60:482–484.

4. Izumi S, Tano K, Horike K, Kaihotsu N. Repeat surgery for hemolysis 6 years after replacement of the ascending aorta for acute aortic dissection. Jpn J Thorac Cardiovasc Surg. 2003; 51:459–461.

5. Nakamura Y, Ogino H, Matsuda H, Minatoya K, Sasaki H, Kitamura S. Hemolytic anemia after operation for aortic dissection using teflon felt strips. Ann Thorac Surg. 2008; 85:1784–1787.

6. Shingu Y, Aoki H, Ebuoka N, Eya K, Takigami K, Oba J, Chiba K, Fukuhara T. A surgical case for hemolytic anemia after ascending and total arch replacement. Ann Thorac Cardiovasc Surg. 2005; 11:416–418.

7. Luzzatto L. Hemolytic anemias and anemia due to acute blood loss. In : Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J, editors. Harrison's principle of internal medicine. 18th ed. New York: McGraw-Hill;2012. p. 872–886.

8. Cesare ED, Giordano AV, Cerone G, De Remigis F, Deusanio G, Masciocchi C. Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms. Int J Card Imaging. 2000; 16:135–147.

9. García A, Ferreirós J, Santamaría M, Bustos A, Abades JL, Santamaría N. MR angiographic evaluation of complications in surgically treated type A aortic dissection. Radiographics. 2006; 26:981–992.