Usefulness of three-dimensional transesophageal echocardiography for diagnosis of hemolytic anemia due to inverted internal felt strip after surgery for aortic dissection

The Utility of Point-of-Care Transesophageal Echocardiography in the Intensive Care Unit for Detecting the Cause of Hemolytic Anemia After Ascending Aorta Replacement

Hemolysis is well-known as a complication after mitral valve surgery, and hemolytic anemia after valvular surgery in the intensive care unit (ICU) usually leads ICU physicians to a careful imaging examination. However, hemolytic anemia following aortic replacement rarely has been described and little is known. The authors present a patient with hemolytic anemia after ascending aortic replacement for type A aortic dissection repair. In the patient, transthoracic echocardiography (TTE), contrast-enhanced computed tomography (CT), and laboratory tests failed to identify the cause of hemolytic anemia. Transesophageal echocardiography (TEE) finally revealed a stenosis of the proximal anastomosis of the graft, with turbulent flow due to protrusion into the lumen. This finding was thought to represent the cause of hemolysis and was sufficient to convince the surgeons to repair the lesion. In the repair surgery, inversion of the inner felt strip that had been applied to the proximal anastomosis of the replacement ascending aorta was confirmed as shown with TEE, and the constricted anastomosis was repaired. Although TTE and CT generally have been used to identify the lesion of mechanical hemolysis after cardiac surgery, point-of-care TEE could have promptly identified the causative lesion in the present patient. Point-of-care TEE in the ICU could become a first-line imaging examination for postoperative hemolysis in cardiac patients.