J Cardiovasc Ultrasound.  2012 Mar;20(1):52-56. 10.4250/jcu.2012.20.1.52.

Cases of Hemolytic Anemia with Periprosthetic Leaks Evaluated by Real-Time 3-Dimensional Transesophageal Echocardiography

• Chung EJ
• Kim TY
• Hwang JM
• Kim SP
• Yang HS

• KMID: 2177342
• DOI: http://doi.org/10.4250/jcu.2012.20.1.52

Abstract

Hemolytic anemia is recognized as a rare complication of mitral valve replacement or repair. We report on a 44-year-old man with shortness of breath and hemolytic anemia, 23 years after mitral valve replacement (Hall-Kaster), and a 63-year-old woman diagnosed of hemolytic anemia, 4 years after mitral and tricuspid annuloplasty (Tailor ring, An-core ring). Routine 2-dimensional transthoracic echocardiography revealed paravalvular leakage around the prosthesis. Subsequent real-time 3-dimensional (3D)transesophageal echocardiography helped the perceptional appreciation of the leakage and the measuring of the regurgitant orifice area using the anatomically correct plane. Surgical findings of each case fit those of 3D volumetric images.

Keyword

Hemolytic anemia; Three-dimensional echocardiography

MeSH Terms

Adult
Anemia, Hemolytic
Dyspnea
Echocardiography
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Female
Humans
Middle Aged
Mitral Valve
Prostheses and Implants

Figure

• 

  Fig. 1 A: A real-time 3-dimensional (3D) transesophageal echocardiography shows a paravalvular leak (arrows) outside of the mechanical mitral prosthesis (mid-posterior) in en-face view from a left atrial perspective, obtained in a single heart beat using 3D zoom mode. B: A full-volume 3D color volume reveals a significant systolic paravalvular regurgitant jet (arrows) and small physiological valvular regurgitant jets (arrowheads), acquired in 7 electrocardiography-gated cardiac cycles.

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  Fig. 2 This one 3-dimensional full-volume image shows the mitral posterior ring and peri-ring tissue defect (arrow) and the tricuspid annuloplasty ring prosthesis (asterisk) which was more than half detached from the anatomical annulus. ANT: anterior, POST: posterior, LAA: left atrial appendage, IAS: interatrial septum.

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  Fig. 3 A real-time 3-dimensional (3D) transesophageal echocardiography zoom image demonstrates a peri-ring tissue defect (arrow) of the mitral posterior ring (arrow) on surgeon's view in end-systole (A) and mid-diastole (B). A full-volume 3D color image reveals the regurgitant jet from the peri-ring defect (arrow), differentiated from valvular regurgitation (C); this view is similar to what the surgeon saw (D).

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  Fig. 4 Postprocessing of the live 3-dimensional transesophageal echocardiography volumetric image using the multi-planar rendering (MPR) mode in QLAB software (Philips Medical Systems, Andover, MA, USA) measures the peri-ring regurgitation orifice area using the anatomically correct plane as 0.61 cm2.

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  Fig. 5 A full-volume 3-dimensional (3D) color transesophageal echocardiography (TEE) image shows the tricuspid ring prosthesis in diastole (A), combined with regurgitation through the ring prosthesis during systole (B). A real-time 3D TEE zoom image reveals the tricuspid ring prosthesis and several thread-like strands caused by detachment from the native annulus (C), which revelation is confirmed in the surgical findings (D).

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