Multiplane Transesophageal Echocardiographic Characteristics of Mitral Paraprosthetic Regurgitation and its Association with Hemolysis

Paravalvular regurgitation (PR) is an uncommon but potentially serious complication of valve replacement operations. This study was designed to determine the relation of PR with the presence and degree of hemolysis and also the effect of flow characteristics on hemolysis. The study group consisted of 45 patients with St. Jude type valve prosthesis in mitral position who were referred to our transesophageal echocard iography (TEE) Jaboratory with the suspicion of presthetic valve dysfunction. Patients with systemic illness were excluded from the study. 31 patients had PR (16 female, 15 male, mean age 44±12 years) and 14 patients (8 female, 6 male, mean age 40±11 years) had only physiological reg urgitat io n. Haematological indices sensitive to hemolysis (total and isoenzymes of LDH, ratio of LDH ı!LDHı, reticulocyte count and serum haptoglobin levels) were measured. Even though reticulocyte count was similar between the two groups, total LDH levels and the LDHı/LDHı ratio were significantly higher in group with PR (p<0.004, p<0.001, respectively). Haptoglobin Jevels were lower in the group with PR (p<0.05). When flow characteristics were analysed among patients with PR, in the hemolysis group, six pat ients had acce le ra tio n, two pa tients fragmentation, three patients collision, two patients deceleration and finally four patients free jet pattem. In patients without hemolysis, one patient had acceleration, two patien ts fragmentat ion, two patients deceleration and finally twelve patients free jet pattern. When the relation between the degree of PR and hemolysis among patients with PR were examined, 55% (12/22) of patients with moderateto- severe PR, and 56% (5/9) of patients with mildto- ınoderate PR were found to have hemolysis. These results suggest that PR, particularly of acceleration and collision flow pattern, is associated with a greater ineidence of hemolysis, whereas no relation exists between the degree of PR and hemolysis .