Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-27T14:20:22.305Z Has data issue: false hasContentIssue false
  • English
  • Français

Mild or subclinical intravascular haemolysis subsequent to transcatheter occlusion of the patent arterial duct

Published online by Cambridge University Press:  19 August 2008

Vachara Jamjureeruk ,
Tawatchai Kirawittaya  and
Vandee Ningsnondh
Vachara Jamjureeruk*
Affiliation:
Pediatric Cardiology Unit andQueen Sirikit National Institute of Child Health(Children’s Hospital), Bangkok, Thailand
Tawatchai Kirawittaya
Affiliation:
Pediatric Cardiology Unit andQueen Sirikit National Institute of Child Health(Children’s Hospital), Bangkok, Thailand
Vandee Ningsnondh
Affiliation:
Hematology Unit, Queen Sirikit National Institute of Child Health (Children’s Hospital), Bangkok, Thailand
*
Dr Vachara Jamjureeruk, MD. Pediatric Cardiology Unit, Queen Sirikit National Institute of Child Health (Children's Hospital), Rajavithi Road, Bangkok 10400, Thailand Tel: 2457870; Fax: 662 9416945/2477065
Get access Rights & Permissions [Opens in a new window]

Abstract

One of the important complications of transcatheter occlusion of the patent duct by insertion of either the Rashkind double umbrella or coil devices is intravascular haemolysis, particularly the severe form which occurs in 0.5–0.6% of cases. The incidence of subclinical or mild intravascular haemolysis including morphologic changes in the red cells, however, is not known, especially in the group of patients with residual shunt. We studied laboratory and haematologic changes in 37 patients subsequent to transcatheter occlusion. Their ages ranged from 2 years 2 months to 11 years 8 months (6.2 + 2.7 years), and the duration of occlusion had ranged from 1 month to 2 years 11 months (1.24 + 0.89 years). In 30 cases we had used the Rashkind double umbrella device, and nine of these patients (30%) had a residual shunt. The other seven ducts were closed with detachable coils, and five of these cases (71%) had residual shunting. There was evidence of mild or subclinical intravascular haemolysis in almost half the cases, although no patient developed acute intravascular haemolysis. Fragmented red cells, blur cells and spherocytes from blood smears were found in up to one-third of the overall series, with no differences found according to persistence of shunting. Haemosiderin was found in the urine of the group with residual shunting and in 13–23% of those with complete occlusion. Serum hypohaptoglobin was found in 9–13% of the patients with a residual shunt, and in 9–23% of those with complete occlusion. Four of the patients had haptoglo-bin levels <50 mg/dl. There were no patients with reticulocytes counts >2% in the blood smears. We conclude that subclinical or mild intravascular haemolysis, along with morphologic changes in the red blood cells, are significant findings subsequent to occlusion of the patent arterial duct with either the Rashkind double umbrella or detachable coils.

Keywords

Transcatheter occlusion of patent arterial ductintravascular haemolysishaemosiderinuriahaptoglobinfragmented red cell
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 1 , January 1999 , pp. 58 - 62
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Porstmann, W, Wierny, L, Warnke Hgersberger, G, Romaniuk, PA. Catheter closure of patent ductus arteriosus: 62 cases treated without thoracotomy. Radiol Clin North Am 1971; 9: 203–218.CrossRefGoogle ScholarPubMed
2.Bash, GE, Mullin, CE. Insertion of patent ductus occluder by transvenous approach: a new technique. Circulation 1984; 70 (suppl. II): 285.Google Scholar
3.Rashkind, WJ, Mullin, CE, Hellinbrand, WE, Tait, MA. Nonsurgical closure of the patent ductus arteriosus: clinical application of the Rashkind PDA Occluder System. Circulation 1987; 75: 583–592.CrossRefGoogle ScholarPubMed
4.Perry, SB, Lock, JE. Front loading of double umbrella devices, a new technique for umbrella delivery for closing cardiovascular defects. Am J Cardiol 1992; 70: 917–920.CrossRefGoogle ScholarPubMed
5.Lloyd, TR, Fedderly, R, Mendelsohn, AM, Sandhu, SK, Beckman, RHIII. Transcatheter occlusion of patent ductus arteriosus with Gianturco coils. Circulation 1993; 88: 1412–1420.CrossRefGoogle Scholar
6.Hijazi, ZM, Geggel, RL. Results of anterograde transcatheter closure of patent ductus arteriosus using single or multiple Gianturco coils. Am J Cardiol 1994; 74: 925–929.CrossRefGoogle ScholarPubMed
7.Nykanen, DG, Hayes, AM, Benson, LN, Freedom, RM. Transcatheter patent ductus arteriosus occlusion: application in small child. J Am Coll Cardiol 1994; 23: 1666–1670.CrossRefGoogle ScholarPubMed
8.Cambier, PA, Kirby, WC, Wortham, DC, Moor, JWPercutaneous closure of the small (<2.5 mm) patent ductus arteriosus using coil embolization. Am J Cardiol 1992; 69: 815–816.CrossRefGoogle ScholarPubMed
9.Redel, DA, Neub, M, Le, TP, Coe, J. A new technique for transcatheter closure of patent ductus arteriosus using a retrievable coil system. Circulation 1993; 88: 11–389 (abst)Google Scholar
10.Syamasundar Rao, P, Sideris, EB, Haddad, J, Rey, C, Hausdorf, G, Wilson, AD. Transcatheter occlusion of patent ductus arteriosus with adjustable buttoned device. Initial clinical experience. Circulation 1993; 88: 1119–1126.Google Scholar
11.Verin, VE, Saveliev, SV, Kolody, SM, Prokubovski, VI. Results of transcatheter occlusion of patent ductus arteriosus with the Batallo-occluder. J Am Coll Cardiol 1993; 22: 1509–1514.CrossRefGoogle Scholar
12.Bridges, ND, Perry, SB, Parnes, I, Keane, JF, Lock, JE. Transcatheter closure of a large patent ductus arteriosus with the Clamshell septal umbrella. J Am Coll Cardiol 1991; 18: 1298–1302.CrossRefGoogle ScholarPubMed
13.Uzun, O, Hancock, S, Parson, JM, Dickinson, DF, Gibbs, JL. Transcatheter occlusion of the arterial duct with Cook detachable coils: early experience. Heart 1996; 76: 269–273.CrossRefGoogle ScholarPubMed
14.Hazama, K, Nakanishi, T, Kinugawa, Y, Matsuoka, S, Mori, K, Tomita, H, Momma, K. Transcatheter occlusion of arterial duct with new detachable coils. Cardiol Young 1996: 6; 332–336.CrossRefGoogle Scholar
15.Hosking, MCK, Benson, LN, Musewe, N, Dyck, ID, Freedom, RM. Transcatheter occlusion of the persistently patent ductus arteriosus: forty-month follow-up and prevalence of residual shunting. Circulation 1991; 84: 2313–2317.CrossRefGoogle ScholarPubMed
16.Tynan, M. Transcatheter occlusion of persistent arterial duct. Report of The European Registry. Lancet 1992; 304: 1062–1066.Google Scholar
17.Ali Khan, MA, AI Yousef, S, Mullins, CE, Sawyer, W. Experience with 205 procedures of transcatheter closure of ductus arteriosus in 182 patients, with special reference to residual shunts and long-term follow-up. J Thorac Cardiovasc Surg 1992; 104: 1721–1727.CrossRefGoogle ScholarPubMed
18.Huggon, IC, Tabatabaei, AHT, Qureshi, SA, Baker, EJ, Tynan, M. Use of a second transcatheter Rashkind arterial duct occluder for persistent flow after implantation of the first device: indications and results. Br Heart J 1993; 69: 544–550.CrossRefGoogle Scholar
19.Ladusans, EJ, Murdoch, I, Francios, J. Severe hemolysis after percutaneous closure of a ductus arteriosus (arterial duct). Br Heart J 1989; 61: 548–550.CrossRefGoogle ScholarPubMed
20.Hayes, AM, Redington, AN, Rigby, ML. Severe haemolysis after transcatheter duct occlusion: a non surgical remedy. Br Heart J 1992; 67: 321–322.CrossRefGoogle ScholarPubMed
21.Foerster, J. Red cell fragmentation syndrome. In: Lee, GR, Bithell, T, Foerster, J (eds), Wintrobe’s Clinical Hematology, 9th edn. Lea & Febiger, Philadelphia, 1993, pp 1211–1231.Google Scholar
22.Kelton, JG, Brain, MC, Hayward, CP. Cardiac hemolytic anaemia. In: Nathan, DG, Oski, FR (eds), Hematology of Infancy and Childhood, 4th edn. WB Sauders, Philadelphia, 1993, pp 1835–1836.Google Scholar
23.Nathan, DG, Oski, FA. Cardiac hemolytic anaemia In: Natham, DG, Oski, FA (eds), Hematology of Infancy and Childhood, 4th edn. WB Sauders, Philadelphia, 1993, pp 518–519.Google Scholar
24.Schaer, DH, Cheng, TO, Aaron, BL. Hemolytic anaemia and acute mitral regurgitation caused by a torn cusp of a porcine mitral prosthetic valve 7 years after implantation. Am Heart J 1987; 113:404–406.CrossRefGoogle Scholar
25.Amidon, TM, Chou, TM, Rankin, JS, Ports, TA. Mitral and aortic paravalvular leaks with hemolytic anaemia. Am Heart J 1993; 125: 266–272.CrossRefGoogle Scholar
26.Grosse-Brockhoft, F, Gehrman, G. Mechanical hemolysis in patients with valvular heart disease and valve prosthesis. Am Heart J 1976; 74: 137–141.CrossRefGoogle Scholar
27.Sigler, AT, Forman, EN, Zinkham, WH, Neill, CA. Severe intravascular hemolysis following surgical repair of endocardial cushion defects. Am J Med 1963; 35: 407–412.CrossRefGoogle ScholarPubMed
28.Verdom, TA. Hemolytic anaemia following open heart repair of ostium primum defect. N Engl J Med 1963; 269: 444–448.CrossRefGoogle Scholar
29.Nevaril, CG, Lynch, EC, Alfrey, CP, Heliums, JD. Erythrocyte damage and destruction induced by shearing stress. J Lab Clin Med 1968; 71: 784–790.Google ScholarPubMed
30.Yoganthan, AP, Sung, H-W, Woo, Y-R. In vitro velocity and turbulence measurements in the vicinity of three new mechanical valve prostheses. J Thorac Cardiovasc Surg 1988; 95: 929–932.CrossRefGoogle Scholar