Forty two consecutive patients who had had valve replacement with St. Jude Medical prosthesis were studied on a view point of intravascular hemolysis. Patients were consisted of 14 mitral valve replacement, and 7 aortic valve replacement, and 21
double,
mitral and aortic, valve replacement. Serum LDH, indirect bilirubin, GOT, hemoglobin levels and reticulocyte count were pursued in postoperative 1st day, 3rd day, 7th day, 14th day, and 21th day. Postoperatively, all patients were not detected
paravalvular leakage on the echocardiographical study. The patients with double valve replacement revealed higher levels of LDH on postoperative 14th day (P<0.05) than those with single valve replacement. Among the patients with single valve
replacement, the patients with aortic valve replacement revealed slightly higher levels of entire postoperative data, but considered insignificant. There was correlation between the severity of hemolysis and the size of replaced aortic valve. In
the
postoperative LDH levels, the patients with small sized-aortic valve (less than 21mm in diameter) replacement revealed higher levels of postoperative 3rd day, 7th day and 14th day than those with large size (more than 23mm in diameter). The
patients
with high level LDH of greater than 800 WU/L on postoperative 7th day were 61.9% (26 of 42). The high LDH frequency of DVR was 71.4% (15 of 21), MVR 50.0% (7 of 14) and AVR, 57.1% (4 of 7).The level of LDH declined gradually thereafter through
postoperative 3 weeks. In conclusion, intravascular hemolysis after prosthetic valve replacement was dependent on position of valve replacement and size of valve. And this study supports the conventional valve selection and usage in our hospital.
The
patients with subclinical hemolysis after valve replacement should be placed on a close observation.
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