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/transient ischemic attack, intracranial hemorrhage, hemolysis, thrombosis, pump exchanges, infections, and postoperative right ventricular failure—were obtained. For the purposes of the study, hemolysis was defined as a lactate dehydrogenase (LDH) level >650 U/L, or as clinically substantial hemolysis resulting in hospitalization. Statistical Analysis Data were analyzed with use of SPSS 19 (IBM Corporation; Endicott, NY). Continuous variables were summarized as mean ± SD. Student t tests were used to evaluate differences in continuous

Postinfarction ventricular septal defect (VSD), a rare and severe complication of acute myocardial infarction (MI), 1 is typically treated surgically. 2 When surgery is contraindicated, transcatheter closure may be an alternative. Residual shunting is not unusual after transcatheter closure of postinfarction VSDs 3 ; however, we found few reports of substantial residual shunting in patients who also had severe heart failure or hemolysis. 4 In 2 such patients (one case, a follow-up study of an earlier report 5 ; the other, more recent), substantial

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, a hereditary defect caused by mutations in the G6PD gene, affects more than 500 million people worldwide. 1 Glucose-6-phosphate dehydrogenase is the principal endothelial source of nicotinamide adenine dinucleotide phosphate (NADPH); as a key determinant of vascular function, it catalyzes the first step in the pentose phosphate pathway. When low G6PD levels impair the ability of erythrocytes to produce NADPH, those cells become susceptible to hemolysis. Recognizing this risk, the United States military

Paravalvular leaks (PVLs) are well-recognized sequelae of surgically implanted prosthetic aortic valves. The reasons for PVL include tissue friability, annular calcification, and infection. 1 Although some PVL patients remain asymptomatic for many years, others develop congestive heart failure or hemolysis and need reoperation. Transcatheter closure by implanting an occluder device has become an alternative to surgery for leak closure; treatment of an aortic PVL can often, in fact, be performed via a femoral artery retrograde approach, with

. 2B ) is an axial-flow intraventricular pump with a length of 55 mm, a diameter of 25 mm, a weight of 85 g, 37 and a flow of 3 to 7 L/minute at speeds of 8,000 to 12,000 rpm. 42 From 1985 to 1991, preclinical studies at The Texas Heart Institute were conducted in 37 calves implanted with the Jarvik 2000, with chronic studies averaging 70 days. Hemolysis levels were elevated from baseline values only slightly with the administration of heparin and warfarin. Neurologic, renal, hepatic, and pulmonary functions were normal. 22 In the late 1990s, clinical

descending coronary artery (LAD). The patient was then referred to our institution for possible coronary artery bypass grafting. The patient's medical history included, at the age of 63 years, hemolysis and chronic anemia that had led to a diagnosis of CHAD. In the past, he had experienced—after exposure to cold—black discoloration of his fingertips, toes, nose, and ears, which symptoms had been followed by dark urine and jaundice. As a result, he took special precautions to dress warmly and avoided going outside during winter months. In addition, hemolysis in

was mostly uncomplicated, except for aspiration pneumonia resulting in respiratory failure requiring reintubation on POD 3. He received induction immunosuppressive therapy with anti-thymocyte globulin because of his chronic kidney disease with standard steroid premedication, and he received a 3-drug regimen similar to that of the first recipient. There was no evidence of postoperative hemolysis. The patient was eventually discharged home on POD 17. Follow-up TTE demonstrated excellent LV and RV function, with an LVEF of 60% to 70%. Right heart catheterization also

hemolysis, and unsuitability in the presence of left ventricle thrombus. 2 , 3 The TandemHeart device (Cardiac Assist Inc) can provide 4 to 5 L per minute of support. Insertion is through the femoral vein and requires image-guided transeptal puncture. The device is highly effective at LV unloading and relieving pulmonary congestion from elevated left ventricle end-diastolic pressure. The downside is that the patient remains bedbound and nonambulatory. The TandemHeart is preload dependent; therefore, RV dysfunction and arrhythmias are poorly tolerated. Other

. Fig. 6. Intraprocedural transesophageal echocardiogram (color-flow Doppler mode) shows the devices deployed in the corrected paravalvular leaks and Gerbode defect. / Supplemental motion image is available for Figure 6. Four days postprocedurally, TEE showed a severely enlarged left atrium (>39 mL/m 2 ) and global depression of right ventricular systolic function; in comparison with previous findings, the mitral regurgitation had decreased in severity. During the patient's hospital stay, self-resolving hemolysis developed and was managed