A Case of Hemolytic Anemia Associated with an Inverted Inner Felt Strip on a Proximal Anastomotic Site for Replacement of the Ascending Aorta for Acute Aortic Dissection

(Department of Cardiovascular Surgery, Chiba Emergency Medical Center, Chiba, Japan, and Department of Cardiovascular Surgery, Narita Red Cross Hospital, Narita, Japan)

Hisanori Fujita Shigeyasu Takeuchi Mitsunori Okimoto
Hiroyuki Watanabe Seiichi Yamaguchi
A 62-year-old man underwent replacement of the ascending aorta for a Stanford type A acute aortic dissection. The proximal stump was reinforced with using internal and external PTFE felt strips, fibrin glue and cellulose fibers. However, hemolytic anemia and hematuria occurred postoperatively. ECG-gated reconstruction CT demonstrated that the hemolytic anemia was induced by collision of red blood cells on the inverted felt strip of the proximal anastomosis. The patient underwent a reparative procedure 1 week subsequent to the initial operation. During reoperation, half of the inner felt strip used for proximal stump fixation was found to be turned up and protruding into the inner lumen. An incision was made in the synthetic graft and the inverting felt material was removed as much as possible, and then a bovine pericardial patch was used as a means of covering the internal felt strip. Here, we report a rare case of hemolytic anemia at the site of an inverted inner PTFE felt strip used for reinforcement of proximal anastomosis. We found that an ECG-gated reconstruction CT is particularly useful in diagnosing this complication around a beating heart.
  Jpn. J. Cardiovasc. Surg. 42:293-296(2013)

Keywords:acute aortic dissection, hemolytic anemia, PTFE felt strip, ECG-gated reconstruction